In order to protect your child’s privacy, we need your written permission to leave detailed phone,
email or text messages regarding your child, including messages that contain health and/or billing
information. Please note that current Notice of Privacy Practices allows us to contact you without
written approval with a courtesy reminder regarding upcoming appointments.
Disclaimer: By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.
Click a signature you want to use:
Copyright © 1999-2024 Hush Communications Canada Inc.