Personal Information Collection, Utilization and Disclosure Form

Our office (Murphy Therapeutic Group) understands the importance of protecting your personal information and we as a group are committed to collecting, utilizing and disclosing your personal information professionally and responsibility.

All staff members who come in contact with your personal information are aware of the sensitive nature of the information you have chosen to disclose to us. Our staff have been trained and informed as to the appropriate uses and protection of your sensitive personal information and to treat it accordingly.

The purposes for personal information collection are as follows:


  • To assess and deliver safe and efficient client care
  • To communicate with the client and the client’s other Health Care Professionals involved in their care. ie. physicians, therapists, chiropractors
  • To allow for communication with the client for scheduling, billing, appointment confirmation and to distribute pertinent health care information
  • For teaching and demonstration purposes, with complete anonymity for the client
  • For auditing and evaluation of the above clinic
  • To assist in invoicing, processing credit/debit cards, and for the collection of unpaid bills
  • To comply with the College of Physiotherapists of Ontario and its legal requirements as laid out in the Ontario Government’s “Personal Health Information Protection Act” (PHIPA). November 1, 2004


We will not, under any circumstance, supply a third party (insurers, legal firms) with the client’s personal information without contacting the client and receiving written consent prior to releasing such information. The client has the right to access his/her personal health information records at any time. The client may also withdraw consent to use such information at any time, which may cause disruption or termination of treatment.