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By submitting this form, I agree that all included information is correct. I also consent to information sharing, collection and disclosure of my personal information in order to facilitate the provision of care and services for myself with MSC and Stonebridge personnel, authorized designate and or emergency contacts. I agree to contact the office immediately if there are any changes to the information supplied in this form, to ensure my records stay up to date. Confidentiality is guaranteed by both Stonebridge and the MSC.
The MSC and Stonebridge are committed to safeguarding your personal information. We are governed by the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Personal Health Information Protection Act (PHIPA).