Consent Forms
Patients may request to release their medical chart information from the Regional Fertility Program to send to another clinic or obtain them from another IVF clinic to be sent to the RFP. The RFP adheres to the College of Physicians and Surgeons of Alberta guidelines which state that this process must be completed within 30 days. Medical records are generally kept for 10 years only. Original records will not be sent but will be photocopied at a patient’s request. All release / obtain information consents require a third party witness signature. The fee for this service is a $25.00 administration fee (includes first 20 pages) and 25¢ per page thereafter of photocopying. A pre-authorized credit card form for request of chart copies is also included with the Adobe Acrobat pdf consent form.
Please indicate whether you would like to have the file faxed, mailed, picked up from our office or sent using secure email. Note that requests for delivery by secure email require a current Electronic Communications Consent on file. When completing the consent please note the following:
- If applicable, BOTH partners MUST sign this consent in order for us to release complete information.
- The consent MUST be WITNESSED by a separate individual.