Written Statement of Information Practices

Collection of Personal Health Information

We collect your personal health information directly from you, or from the person acting on your behalf. Examples of the type of personal health information that we collect may include, your name, date of birth, address, health history, records of your visits to Jennifer Lake and details of the treatment that you received during your visits. We may sometimes collect personal health information about you from other sources, if we have obtained your consent to do so, or if the law permits.

Uses and Disclosures of Personal Health Information

We may use and disclose your personal health information for the following purposes:

• Treat and care for you;
• Receive or directly invoice for your treatment and care (e.g., WSIB, private insurer, others);
• Plan, administer and manage our internal operations;
• Conduct risk management and quality improvement activities;
• Teach;
• Compile statistics;
• Comply with legal and regulatory requirements; and
• Fulfil other purposes permitted or required by law.

Your Rights

You may access and correct your personal health records, or withdraw your consent for some of the above uses and disclosures (subject to legal exceptions) by contacting our Contact Person.

Our Responsibilities

We take steps to protect your personal health information from theft, loss, unauthorized access, copying, modification, use, disclosure, and disposal.

We conduct audits to monitor and manage our privacy compliance.

We take steps to ensure that everyone who performs services for us protects your privacy and only uses your personal health information for the purposes for which you consented.

Contact Us

Our Contact Person is:  Jennifer Lake . To find out more about our privacy protection practices, or to raise any concerns, contact our Contact Person at:

You have the right to file a complaint to the Information and Privacy Commissioner/Ontario if you think we have violated your rights.  The Commissioner can be reached at:

Information and Privacy Commissioner of Ontario

2 Bloor Street East, Suite 1400

Toronto, ON     M4W 1A8

(416) 326-3333

Long Distance: 1-800-387-0073

FAX: 416-325-9195.