Privacy Complaint Form

York Region is committed to addressing your concerns about the way your personal health information is collected, used, or shared under the Personal Health Information Protection Act, 2004.

If you have a concern about our privacy policies or procedures, please use this form to file a complaint to our office.

Notice of Collection

Information is being collected and will be retained, used, disclosed and disposed in accordance with the Personal Health Information Protection Act, 2004, S.O. 2004. For more information about our information practices, please visit privacy and disclaimer. Any questions regarding this collection may be directed to @email or 1-877-464-9675 ext. 73007

Contact Information

First Name:

Last Name:

Email:

Phone Number:

Description

Please provide a detailed description of your privacy complaint.

Date:

By checking this box, I confirm that the information provided is accurate and complete to the best of my knowledge, and I acknowledge that this electronic confirmation is the legal equivalent of my signature.