Due to COVID-19, our office procedures have been changed. We require that patients complete and submit this form within 48 hours of booking an appointment.

"We" and "our" mean Spadina Optometry.

We collect, use and share your personal information for the following purposes: your ongoing eye care; to provide services to you; to understand your eligibiltiy for benefits and/or services; to arrange payment for services; and as required by law.

The collection of this information is authorized by the Health Insurance Act, Optometry Act, Regulated Health Professions Act and Health Protection and Promotion Act.

We will take all reasonable steps to ensure that your personal information is treated confidentially and is only used for the purposes it was collected. We will take all reasonable steps to prevent unauthorized access, use or disclosure of your personal information.

You may obtain access to your personal information stored by us in accordance with the Personal Health Information Protection Act by making a written request to: Privacy Officer, Spadina Optometry, 809-477 Richmond St. W., Toronto, ON M5V 3E7

More information about our collection, handling and protection of personal information is available in our privacy policy, posted online at https://spadinaoptometry.ca/privacy-policy/

If you would like to make a complaint regarding the collection, use, disclosure or handling of your personal information you may contact: privacy@spadinaoptometry.ca

You also have the right to complain to the Information Privacy Commissioner / Ontario, 1400-2 Bloor Street East, Toronto, ON M4W 1A8 (800)-387-0073