Confidentiality Agreement

I will respect the privacy of all patients in this treatment environment. I will not disclose the identity of any patient in the Cedars’ facility, nor will I fail to keep confidential anything seen or heard while on the Cedars’ property. It is essential to remember while talking with family or friends about your treatment experience that you only share information about your own experience and not reveal the identity or experience of a fellow patient. The staff at Cedars may be obligated to breach confidentiality in accordance with federal and provincial laws.

I agree to abide by the terms of this agreement.

Patient Name(Required)

First Last

Visitor's Name(Required)

First Last

Date(Required)

Relationship to patient(Required)

Your address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Signature(Required)

Confidentiality Agreement

We Support Inclusion

We are accredited by the following organizations