MedChart - Wellness View Psychological Services Ontario

Organization Information

Welcome to Wellness View Psychological Services Ontario's release of information process. Please complete the following information to submit your request.

Organization Name *

Organization Type *

First Name *

Last Name

Province *

Email *

Phone *

SDM Type *

First Name *

Middle Name

Last Name *

Relationship to client *

Contact Email

SDM Document *

Patient Information

Who are you requesting for? All fields are required.

Patient File Number

Patient First Name *

Patient Last Name *

Patient Date of Birth (YYYY-MM-DD) *

Patient Email

Patient Phone

Not submitting a healthcard number may result in your request taking longer than usual or risking rejection.

Patient Health Card Province

Patient Health Card Number

Please ensure that all information submitted here matches the patient's health card. Providing information that does not match the health card will incur slower processing and the possible rejection of the request.

Request Details

Please indicate the date range and records you are requesting.

Please ensure this information is correct.

Start Date

End Date *

Please select what types of records you would like to order from Wellness View Psychological Services Ontario.

Available Products

Records / CNRs

Select a provider

Special Notes

More info

Organization Information

Before we begin,

Patient Information

Request Details

Information Summary

Request and Invoice Summary

Total: $

Authorization and Documents

Payment Information

Total: $