Authority to Release & Obtain Information

INFORMED CONSENT- authority to obtain and release information relative to workplace rehabilitation services

To commence and/or maintain ongoing in-person services you acknowledge you:

• Provide consent for CorpFit to release and/or obtain medical and other information considered
  relevant to my treatment.


• Have been provided with written information as to how CorpFit may collect and use my personal
  information.


• Throughout the program, should you have concerns or questions about any recommended treatment,
  you must inform the therapist immediately so rationale for treatment and/or adjustments to your
  treatment can be made.


• It is your responsibility to participate in all aspects of the program as it is imperative to its success.
• 
  You agree to this consent remaining valid until such time as consent is withdrawn.

I have read the information above and understand the reasons why my information must be collected, and the purposes for which my information may be used or disclosed. I understand that if my information is to be used for any purpose other than that set out above, my further consent will be obtained.