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Freedom of Information Request

A $5.00 application fee is required for each request.

Payment may be made by mail or in person at Muskoka Algonquin Healthcare, 100 Frank Miller Drive, Huntsville, Ontario P1H 1H7. Make your cheque or money order payable to Muskoka Algonquin Healthcare.

Part 1

This request is for:

Access to General Records

Access to Own Personal Information

Correction of Own Personal Information

Part 2 - Requester's Information

Last Name

First Name

Unit Number

Street Number

Street Name

City/Town

Province

Postal Code

Telephone number

Email Address

Detailed description of requested records, personal information requested or personal information to be corrected.

Note: If you want a correction of personal information, please describe the correction you want and attach any supporting documents you may have. You will be told if the correction is not made and you may attach a statement of disagreement to your personal information.

Upload any supporting documents.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Preferred method of access to records:

Examine original

Receive copy

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Personal information contained on this form is collected pursuant to the Freedom of Information and Protection of Privacy Act and will be used for the purpose of responding to your request.

Questions about this collection should be directed to the attention of the Privacy Officer at:

Muskoka Algonquin Healthcare

100 Frank Miller Drive, Huntsville, ON P1H 1H7

705-789-2311 ext. 6001