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Colon Cancer Screening - Follow-Up Consent Form


We are eager to understand the meaningful impact of our work on the community. If you are 50 years of age or older, do not* have a family doctor, and wish to request a FIT through Health 811 (811), please complete the following consent form. This will enable the West Toronto Ontario Health Team to follow up with you to determine if you have:

a) called Health 811 (811)

b) received a FIT 

c) sent a FIT to a lab 

d) if you were connected with a family doctor through Cancer Care Ontario (program connected to Health 811) 


Under no circumstances will we share your personal information with any individuals or organizations without your explicit permission, whether they are public organizations, corporations, or individuals, unless mandated by law. We do not engage in the sale, communication, or disclosure of your information to any mailing lists.

Maximum 255 characters

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2.  

Please indicate whether or not you plan on calling or have called Health 811

* required
3.  

Do you consent to the WTOHT following up with you at a later date to see if you successfully called health 811, secured a FIT, and got connected to a physician through the Cancer Care Ontario program?  

* required

Maximum 255 characters

0/255