(all dietitians follow the Personal Health Information Protection Act)


I understand that Nicole Korodetz RD is a registered dietitian and does not dispense medical advice or prescribe treatment. Rather, she provides education to enhance my knowledge of food and nutrition, and counselling to make and maintain behaviour changes related to health.

Consent for Personal Information:

I accept that it will be necessary for Nicole Korodetz RD to collect personal, health, and lifestyle information (e.g. home address, telephone, medical history, diet history, activity level, social situation etc). This is to help Nicole Korodetz, RD assess your needs, advise you of your options, and then provide the dietetic intervention deemed most appropriate.

Use, Disclosure, and Retention of Information:

I understand that only information relevant to the provision of services for my medical/nutritional management will be collected, and that this information will be retained for ten years following the last date of service (or 10 years following my eighteenth birthday, whichever is longer). All information is kept confidential, and stored in a secure location. Your information is protected according to guidelines outlined by the Personal Health Information Protection Act.

The Personal Health Information Protection Act, 2004 is an Ontario law that governs the collection, use and disclosure of personal health information within the health sector. The object is to keep personal health information confidential and secure, while allowing for the effective delivery of health care. Under this legislation, persons and organizations that provide health care are collectively known as health information “custodians”.

Access to Information

I understand that I may review the information in my file for accuracy and currency. If I disagree with the information, I accept that either a correction will be made or my disagreement will be noted. I understand that I may ask questions about the Privacy Policy, and have them answered to my satisfaction. This is available to you at any time. I agree to Nicole Korodetz, RD collecting, using and disclosing my personal information as set out above and in the Privacy Policy.