Give us a call

Lower Mainland:
604.734.7125
Vancouver Island:
250.595.7125
Southern Interior:
250.861.7125

Medical Records Release Form

Medical Records Release Form

"*" indicates required fields

Patient Information

Full Name*

Consent

Patients of InspireHealth requesting services have the right to Informed Consent; that is, your full and active participation in decisions which affect you and your freedom of choice based on the information shared. InspireHealth respects your right to ongoing informed consent at the outset of the therapeutic relationship and throughout your care. You have the right to withdraw consent at any time and terminate services. When it comes to the direction and goals of your therapy, you are the primary decision maker. You have the right to accept or reject any task, exercise, or practice suggested by your clinician, and to be informed of the risks, benefits, rationale, alternatives, and interpretations of all suggested interventions.
5. CONSENT TO ALLOW THE RELEASE OF MEDICAL INFORMATION FROM BC CANCER, ONCOLOGISTS, OR OTHER SPECIALISTS
E-Signature*
MM slash DD slash YYYY