PIPEDA Consent Form

PIPEDA Fair Information Principle 3 – Consent

How I collect, Use and Disclose Clients' Personal Information

I understand the importance of protecting your personal information. To help you understand how I am doing that, I have outlined here how my office is using and disclosing your information.

This office will collect, use and disclose information about you for the following purposes:

to advise you of promos via email campaigns (via gmail)

to establish and maintain communication with you when necessary

for teaching and form discussion purposes on an anonymous basis with absolute no reference to personal information

to process credit card payments via Square, bank transfer and Paypal (where applicable).

to comply generally with the law

storing a copy of the session for up to 7 years. Filed with a numerical naming convention and backed up on an external hard drive, password protected.

By signing the consent section of this Client Consent Form, you have agreed that you have given your informed consent to the collection, use and/or disclosure of your personal information for the purposes that are listed above. If a new purpose arises for the use and/or disclosure of your personal information, we will seek your approval in advance.

Client Consent

I have reviewed the above information that explains how your office will use my personal information, and the steps your office is taking to protect my information.

I know that your office has a Privacy Code, and I can ask to see the Code at any time.

I agree that Angela Solorzano; CH, RM , use and disclose personal information about (name of minor child if necessary in the blank below), as set out above in the information about the my office’s privacy policies.

First Name

Last Name

Date

By signing below, I have read the above Confidentiality & Consent, Disclaimer, Liability Waiver and Acknowledgement of Risks/Responsibilities and understand what I have read.

Thank you!

PIPEDA Consent Form

PIPEDA Fair Information Principle 3 – Consent

How I collect, Use and Disclose Clients' Personal Information

Client Consent

REGARDING?

Disclaimer: Hypnosis and/or Reiki is not intended to cure any specific condition. I make no claims of a cure for any disease. Success is dependent on the client's belief system.
Copyright© 2024 by Angela Solorzano.