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Sleep & Wake Clinic Group Consent Form

Consent Form  

                                  

I hereby give my consent to undergo the investigation and treatment, as ordered by or to be performed by the Physicians at the Sleep & Wake Clinic.

I understand I will receive a detailed explanation of the nature and anticipated effects of the proposed investigations and procedures, including its significant risks and available alternatives. At the time of discussion, I confirm that I fully understand the explanations provided regarding the treatment processes ahead and that I am satisfied with the information given.

 

 

Confidentiality and Privacy

  • Other patients will be present during the session.
  • The healthcare provider will present general medical educational information only and will not discuss individual patient cases or personal health details.
  • You are not required to share any personal medical information during the session.
  • You are welcome to make comments and ask questions.

While the clinic and healthcare provider are committed to protecting your privacy in accordance with Alberta’s Health Information Act (HIA), confidentiality cannot be fully guaranteed in a group setting. However, participants are expected to respect the privacy of others and not share any information discussed or heard during the session outside the group.

 

 

Limits of the Session

  • No specific individual diagnosis, treatment decisions, or medication changes will be made during the group session.
  • If you require personal medical advice or assessment, you will have the opportunity to schedule a separate individual appointment with your healthcare provider.

Voluntary Participation

Participation in this group session is voluntary. You may decline to participate or leave the session at any time without affecting your access to medical care.

Consent

I understand and appreciate the purpose and format of Group Medical Visits (education sessions). I understand the privacy considerations and the potential limits of confidentiality in a group setting. I agree to participate and to respect the privacy of other participants.

Please Fill Out Your Name In Full Below

 

Printing your name in full will be considered equivalant to your electronic signature 

Please complete the date of your signature

This serves as your E-signature for this consent.

Withdrawal of Consent:

 

You may withdraw your consent to participate in Group Medical Visits (education sessions) at any time by contacting the Sleep & Wake Clinic at admin@sleepwakeclinic.com.

This means you can revoke your agreement for treatment or participation at any time.

 


  Thank you for taking the time to complete this consent form.

 

 

 
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