Your health information includes any information or opinion about your health, including (but not limited to) any illness, disability or injury, any health service provided (or to be provided) to you, any genetic information about you in a form that is, or could be, predictive of your health, and any other personal information collected to provide, or in providing, health services to you. Stella must not collect or disclose your health information, without your consent.
You can withdraw your consent at any time by contacting Stella via email@example.com. However, please note that if we cannot collect, use or disclose your health information as contemplated in this Health Information Consent Form, then it is likely that we will not be able to provide our services to you.
By indicating your consent in accordance with this Health Information Consent Form, you authorise Stella to collect, use and disclose your health information as follows: