Consent to release of information form

Name: Consent to release of information form
Category: 
Health and wellness
Last updated: August 26, 2021
Size: 31.74 KB
File Type: PDF
Number of pages: 
1
Document description: 

This form is to consent to the disclosure of health information to another person. It should be filled out and submitted to a privacy officer.

For more information, learn about how we protect your health information. Or,  email healthprivacy@yukon.ca or phone 867-456-3953, toll free 1-800-661-0408 extension 3953.

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