MedReleaf – Applicant Consent

In the case of a prospective patient, the user acknowledges that he or she is interested in learning more about MedReleaf and is considering becoming a patient in the future. To learn more about our Privacy Practices please see our Privacy Policy

If the applicant has registered as a patient, caregiver or doctor the following applies:

By signing, the applicant and/or caregiver responsible for the applicant acknowledges that they have read, understood and agree that:

The Applicant agrees that MedReleaf Corp. may collect, use, disclose and store his/her personal information and personal health information provided by the Applicant, his/her caregiver or his/her healthcare professional(s) (collectively, the Applicant’s “Information”) to determine his/her eligibility for, and registration as, a client of MedReleaf Corp and for the purpose of filling orders and providing information about MedReleaf and its products and services and for the purpose of obtaining and processing payments by, or on behalf of, the Applicant as applicable.

The Applicant authorizes MedReleaf Corp. to disclose information to, and obtain further information from his/her caregiver and his/her healthcare professional(s) to ensure the accuracy and completeness of this application and to register the Applicant as a client of MedReleaf Corp. The Applicant understands and agrees that a copy of this consent & registration application may be provided to the health care practitioner.

The Applicant understands that MedReleaf Corp. will collect, use and disclose his/her Information in connection with the following MedReleaf Corp. services:

By signing below the applicant acknowledges that they have read, understood and agree that: MedReleaf Corp. will collect, use, disclose and store his/her personal information as outlined above and as set out in MedReleaf’s Privacy Statement, and that MedReleaf Corp. may from time to time de-identify the Applicant’s Information for research, medical educational, business analytics and other commercial purposes, including by combining the Information with other data for such analyses.

I agree to receiving electronic messages containing news, updates and promotions from MedReleaf regarding its products and activities. Note you can withdraw your consent at any time.