This Authorization to Release Confidential Information will ensure that only the information you specify is released on your behalf. This authorization can be given to a physician, attorney, hospital, clinic or school. The confidential information to be released can vary from financial, educational and legal to your social interactions, both online and in person. This Authorization is beneficial because it protects your privacy, contains an expiration date and can be revoked at any time.

These important provisions are included in this Authorization:

• Authorization Information: Indicates the name and address of the individual authorizing release of the information and the individual or entity who will release the confidential information;
• Types of Confidential Information: Sets forth a checklist covering most types of confidential information;
• Purpose of Use: Outlines the purposes the confidential information may be used for;
• Revocation and Expiration Dates: This Authorization may be revoked at any time or on a specified expiration date.

Protect yourself and your rights by using our professionally prepared up-to-date forms.

This lawyer prepared packet includes:

1. General Information
2. Instructions and Checklist
3. Authorization to Release Confidential Information for use in Canada

Law Compliance: This form can be used in the following provinces: Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Nunavut, Ontario, Prince Edward Island, Saskatchewan and Yukon