OSHAWA-DURHAM SLEEP LABORATORY INC.

Sukarno N. Chaudhry, FRCPC, ABIM • Varinderjit S. Parmar, FRCPC • Malcolm Blagrove, MD, FRCPC, DRCPSC

Primary Method of Contact / Email Communication Consent Form

Updated

January 2026

Consents-Primary Method Of Contact & Sleep Study Instructions

Email Communication Consent

Email is convenient, but not risk-free. Please review the information below and complete the form.

Under Ontario’s PHIPA, explicit and informed consent is required before communicating personal health information by email.

Email is for non-urgent matters only. For urgent concerns, contact the clinic by phone or seek emergency care.

Risks of Email Communication

Please read carefully before providing consent.

Important

Email is not appropriate for urgent matters or medical emergencies.

Technical failures, delays, or security breaches may occur.

Emails may be accessed by anyone who has access to your device or email account.

Emails sent to shared, family, or employer-controlled accounts may be viewed by others.

Emails may be misdirected, intercepted, forwarded, altered, or stored by third-party providers.

I have read and understand the risks associated with email communication.

Use of Email Communication

If you provide consent, email may be used for non-urgent communication only.

Info

Appointment confirmations, reminders, and instructions.

Preparation forms and information packages.

Requests for missing or incomplete information.

Administrative documents.

General non-urgent communication related to your care.

Sensitive PHI (e.g., diagnostic reports, prescriptions, medical records) will only be sent by email when specifically requested and explicitly consented to.

Preferred Method of Contact

Choose your primary method of contact and provide the details.

Required

Please select a preferred contact method above to enter your details.

It is your responsibility to notify the clinic if your contact information changes. Missed appointment fees may apply if we are unable to reach you.

Email Consent Options

Select one option below.

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Patient Acknowledgement and Consent

Please complete the fields below.

Required

Patient Name *

Date of Birth *

Patient Signature *(Draw your signature - legally binding)

I understand that my electronic signature, whether drawn or typed, is the legal equivalent of my manual/handwritten signature and that I am consenting to the terms and conditions of this document.

Date *

You may withdraw or change your consent at any time by notifying Oshawa-Durham Sleep Laboratory in writing. Email communications relevant to your care may be added to your medical record.

We are here for you when you need us! Call us to schedule an appointment.

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