Written Public Statement Regarding Our Privacy Commitment

We are committed to protecting your privacy and ensuring the confidentiality of your personal health information. The types of personal health information we collect may include your name, contact information, date of birth, health history, insurance information, and records of the care provided to you. We collect, use and disclose personal health information for the following purposes:

• to provide counselling and/or psychotherapy to our clients
• to obtain payment (from you, WSIB, your private insurer or others) for the services provided
• to teach students and to provide continuing education to our staff
• to conduct quality improvement and risk management activities
• to comply with our regulatory obligations to our regulatory colleges
• to advise clients about special events or opportunities (but we will always obtain express consent to do so)
• for other purposes permitted by law

We will collect, use and disclose only as much personal health information as is needed to achieve these purposes. You can withhold or withdraw your consent to the collection, use or disclosure of your personal health information by contacting us (details below).

You have the right to seek access to your health records that we keep and to ask us to correct a record if you believe it is inaccurate or incomplete. Please contact us for more information. 

If you have questions or want to make a complaint about our privacy practices, please contact:

Melika Montazery and Mandana Montazery

7030 Woodbine Avenue, Suite 500, Markham, Ontario, L3R 6G2 

info@starflowerpsychotherapy.com

(647) 388-8272

You also have the right to complain to the Information and Privacy Commissioner of Ontario at the address below if you have concerns about our privacy practices or how your personal health information has been handled:

Information and Privacy Commissioner/Ontario

2 Bloor Street East, Suite 1400, Toronto, Ontario M4W 1A8

Telephone: Toronto Area: (416) 326-3333

Long Distance: 1 (800) 387-0073 (within Ontario)

TDD/TTY: (416) 325-7539

FAX: (416) 325-9195

www.ipc.on.ca