Patient Consent Requirement: By entering my name below I understand that the personal information collected about me (and/or my family) and held by 20/20 Eye Care shall be limited to that which is necessary for the provision and billing for optometric services and communication with me, authorized health care providers or insurers relating to that care. I understand this information may also be disclosed to the practice’s consultants or other persons contracted to maintain the practice’s business, to a succeeding or purchasing optometric or medical practice, or to regulatory authorities for the purpose of complaints, investigations, or stand reviews. I understand that the practice will keep my personal information confidential and secure. I hereby authorize 20/20 Eye Care to collect, use, and disclose my personal information as described above.
Email Consent Requirement: I consent to 20/20 Eye Care sending me publications containing announcements, promotions and other information about products and services by e-mail and other electronic communications. I understand I can withdraw my consent at any time by contacting 20/20 Eye Care at 2-835 Dakota Street Winnipeg MB R2M 5M2, 204-953-2020.
I consent to 20/20 Eye Care sending me appontment reminder and/or recalls by e-mail and other electronic communications