The resources on this page are specific to Canada and PHIPA/PIPEDA.
If you want to use your own documents to collect consent for processing personal data, rather than emailing your clients through Upheal, we offer two options. Choose the one that best suits your practice:
Add a simple statement to your existing documents.
or
Use and distribute our template as-is or modified to your practice's needs. The template is the same form that you can email to your clients through Upheal.
Statement for existing forms
If you already have your own informed consent documents, you can include Upheal in your forms by adding these statements to remain PHIPA/PIPEDA compliant while using Upheal.
Make sure to replace [Name of the practice] with your own practice.
[Name of the practice] uses external providers to enhance services including the Upheal platform. Upheal empowers counselors to concentrate on their services by offering automated notes and analytics for client conversations. As a part of this process, Upheal handles protected health information for counselors, adhering to PHIPA and PIPEDA regulations.
[Name of the practice] has signed an agreement to protect data that is shared with Upheal. Under the DPA, Upheal adheres to regulations such as the PHIPA and PIPEDA. This ensures that electronic health information (ePHI) is safeguarded through appropriate administrative, physical, and technical measures, ensuring its confidentiality, integrity, and security. You can learn more about Upheal and its privacy practices at www.upheal.io/privacy.
Template for new forms
If you need a new consent form, you can download and use our template.
Please note:
The template is intended to serve as a basis for client consent and might require customization according to your specific operation and obligations. You as a Provider are responsible for the accuracy and applicability of the document.
Last Update: June 21, 2024
If you'd like to make changes to the form, make a copy or download the document.
How to make a copy in your Google Drive
How to make a copy in your Google Drive
Click File > Make a copy.
Rename the document, choose the folder to save it in, and click Copy.
How to download for editing on your computer
How to download for editing on your computer
Click File > Download.
Choose which file type you want to download, such as Microsoft Word (.docx).
The download starts automatically, and then you can edit the new file on your computer.