Patient Consent Forms

Patient Consent Form

Healthcare Institution Name:

Empathia AI is a technology solution software powered by advanced AI (artificial intelligence) to assist your Healthcare Provider in capturing the important details of your visit.

Empathia strictly complies with Canadian privacy laws, including the Personal Information Protection and Electronic Documents Act (PIPEDA) or applicable provincial legislation such as Ontario’s Personal Health Information Protection Act (PHIPA), British Columbia’s Personal Information Protection Act (PIPA).

By signing this form, you provide voluntary consent for the recording and processing of your conversations to create accurate medical documents for your doctor. You retain the right to withdraw consent at any time, with alternative documentation methods available.

Patient Name:

Patient Signature                                                        Date