*Une version française suit ce message*

Hello,

You are receiving this message as you were once a client of mine during a massage session.

On March 1, 2024, your medical information was obtained without my consent by a group of physiotherapists called PCN. As such, the Law mandates that you be contacted and the events explained.

Your medical file is being introduced by the physiotherapists into a court file in Quebec superior court following the beginning of a lawsuit by me.

Steps have been taken to have the court remove these files and orders them to be destroyed.

However, your consent to this sharing or refusal to consent is important. Therefore, this quick checkbox form allows the court to know whether you’ve agreed to this or not.

Please fill this quick form to tell the court whether you’ve consented to this use of your private medical information.

Depending on your answer, steps will be taken to ensure the appropriate outcome occurs.

I am sorry for this situation, this was not expected and I offer my apologies for this.

Regards,

Maxime Marois

Massage therapists.

Vérification du consentement au partage d'un dossier médicaux de massothérapie / Verification of consent to sharing of a massage therapy medical file

Français

Vous êtes ici car votre dossier ou une partie de votre dossier en massothérapie à été obtenu sans mon consentement par le groupe PCN et introduit dans un dossier en Cour supérieure.

Le présent formulaire a pour objectif de vérifier votre consentement à ce partage et à cette utilisation.

_______

English

You are here today as your massotherapy medical information or a part of them were obteinaned without my consent by the physiotherapy group PCN and introduced into a court file in Superior court (Québec).

The present form as for goal to verify your consent to these actions.

*Nom complet / Full name

J'ai consenti à ce que PCN obtienne une copie de mon dossier de massothérapie / I have given my consent to the sharing of my medical file with the group PCNEst-ce que votre consentement vous a été demandé et l'avez-vous donné? / Was your consent asked and did you give it?

Oui/Yes

Non/No

Consentement/ConsentJ'ai consenti au fait que PCN St-Sacrement soit en possession de mes informations et les utilises dans un dossier en Cour / I have consented for PCN St-Sacrement to be in possession and use my medical information in a Court file

Oui/Yes

Non/No

*Je désire que mon dossier soit privé / I required that my file be private

Oui/Yes

Non/No

Merci d'avoir complété le formulaire. Des actions seront entreprises en conséquence de vos réponses. / Thank your for having taken the time to fill this form. Actions will be taken in response to your answers.