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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:

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.

Thank you!

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