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*PATIENT ACKNOWLEDGEMENT AND AGREEMENT: I acknowledge that I have read and fully understand the Email Policy. I understand the risks associated with the use of communication by email between the Physician and me, and consent to the conditions outlined herein, as well as any other instructions that the Physician may impose to communicate with patients by e-mail. I acknowledge the Physician’s right to, upon the provision of written notice, withdraw the option of communicating through e-mail.

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1723 Kipling Ave. #4 Etobicoke, Ontario, M9R 4E1

Walk in : 416-244-8404 Children's Clinic : 416-244-7617

Westwaymedicalclinic@gmail.com

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General, Family Practice & Walk-in Form

Electronic Communication Consent Form

1723 Kipling Ave. #4
Etobicoke, Ontario, M9R 4E1

Walk in : 416-244-8404
Children's Clinic : 416-244-7617

General, Family Practice
& Walk-in Form