Patient Forms

Communicate With Our Office by Email

Before sending us an email, please review how email communication works at Apple Hills Medical Associates — then download, sign, and submit your consent form.

Before You Email Us

What You Need to Know Before Emailing Us

In order to communicate with our office via email there are some limitations on how we can communicate with you by email, which we will explain here.

When you contact us via email you give Apple Hills Medical Associates permission/consent to respond to your email which may include your Personal Health Information.

You may also wish to review our Consent to Disclose Personal Health Information form, which covers related privacy considerations for sharing your health records.

Please Read Carefully

Important Limitations of Email Communication

Not a Substitute for Clinical Assessment

Email communication is not a substitute for clinical assessment. Although technology is changing, the best way to share information with your health care provider is in person.

Not for Emergencies or Time-Sensitive Issues

Email communication should not be used to communicate emergencies or time sensitive health care issues. If you are experiencing an emergency, you should call 9-1-1 or go to the nearest hospital immediately.

Email Is Not Fully Secure

Standard email is not a fully encrypted channel. By consenting to email communication, you acknowledge and accept the inherent privacy risks of transmitting personal health information electronically.

Your Next Step

Download, Sign & Submit Your Consent Form

Please print the attached form, sign and either bring it in to our office at your next Doctor's appointment or it can be mailed to 1221 Bloor Street East, Mississauga, Ontario L4Y 2N8.

PATIENT EMAIL CONSENT FORM.pdf

Adobe Acrobat Document — Print, sign, and return

How to Submit Your Signed Form

In Person

Bring the signed form to your next Doctor's appointment

By Mail

1221 Bloor Street East
Mississauga, Ontario L4Y 2N8

Questions? We're Here to Help

If you have questions about email communication or need help with your consent form, our team is happy to assist.