Terms and Conditions
U-Breathe is collecting and using your personal information such as: Name, e-mail address, and any additional information which you provide for the purpose of providing health services including the most comprehensive and timely care (HIA section 20(b)). The information provided will remain confidential within U-Breathe and never be shared with third parties. Data collected from this form will not be stored on the website and is destroyed after it is used. The collection of your personal information is authorized by section 33(1)(c) of the Freedom of Information and Protection of Privacy Act. Any questions concerning the collection, use or disclosure of your personal information may be directed to U-Breathe at 1-403-475-9766. You may also write to U-Breathe: Suite 205, 4411 16 Ave NW, Calgary AB, T3L 3E6 Or email us at firstname.lastname@example.org
Click on the “I Understand” checkbox below to confirm your acceptance. By doing so, you are indicating that you have read and understood these terms and conditions and you are providing U-Breathe with consent to collect and use your personal information as indicated above.
New Patient Questionnaire
Please answer the following questions to the best of your ability. If you do not understand the question or need help answering it, you may skip it and proceed to the next one. These questions will help us provide the best and most comprehensive assessment of your breathing concerns.