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Individuals Portal

Mandate & Information Release for Individuals

Download this form if you are an individual who wants to initiate the My Medical Director or the Medical Concierge. After filling out the form and scanning it, you may upload it using the form at the right.

    Maximum File Size = 2MB
    Consent to the Collection and Use of Personal Information

    By submitting documents through this website, you consent to the collection, use, and retention of your personal information in accordance with applicable laws, including Quebec Law 25 respecting the protection of personal information.

    Nature of Information Collected

    The documents you submit may contain personal information and, where applicable, sensitive or medical information.

    Purpose of Collection

    This information is collected solely for the purpose of:

    • assessing your clinical or administrative situation
    • providing appropriate professional services
    • ensuring follow-up and management of your file

    Access and Confidentiality

    Your information is accessible only to authorized professionals and team members who require it in the course of their duties. Appropriate security measures are in place to protect the confidentiality and integrity of your data.

    Disclosure to Third Parties

    Your information will not be disclosed to third parties without your consent, except where required by law or necessary for the provision of services (e.g., involved healthcare professionals or authorized partners).

    Retention and Storage

    Information is securely stored for the period necessary to fulfill the purposes for which it was collected, in accordance with legal and professional obligations.

    Your Rights

    You have the right to:

    • access your personal information
    • request correction of your information
    • withdraw your consent, subject to legal and contractual obligations

    Consent

    By uploading your documents, you confirm that:

    • you are authorized to share this information
    • the information provided is accurate to the best of your knowledge
    • you consent to its use as described above