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Consent to Release Personal Information
A sworn consent authorizing an organization to release your personal information or records to a named person or body — for medical, financial, school, or employment records. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Pay only when you notarize
Word files are editable. Review any changes carefully before signing or uploading.
Also known as
- Authorization to Release Records
- Information Release Consent
- Records Release Authorization
+1 more names
- Consent to Disclose Information
CONSENT TO RELEASE PERSONAL INFORMATION
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I am the person to whom the information described below relates.
Date of birth:I authorize ______ to release the following information or records: ______, to ______.
Limits, dates or conditions on this consent (if any):
I give this consent freely. This consent remains in effect until I revoke it in writing.
Purpose of the release:
I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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- General template, not legal advice
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Consent to Release Personal Information
A compact preview of this template
01Your Information
Your full legal name
Your date of birth
Your full address
CONSENT TO RELEASE PERSONAL INFORMATION
I, ______, of ______, in the Province of Ontario, SOLEMNLY DECLARE that:
I am the person to whom the information described below relates.
Date of birth:I authorize ______ to release the following information or records: ______, to ______.
Limits, dates or conditions on this consent (if any):
I give this consent freely. This consent remains in effect until I revoke it in writing.
Purpose of the release:
I make this solemn declaration conscientiously believing it to be true and knowing that it is of the same force and effect as if made under oath.
Signed and sworn (or affirmed/declared) before me by videoconference in Ottawa, Ontario, while the Affiant(s)/Declarant(s) were located in ______________________, on ______________________, pursuant to O. Reg. 431/20, and Electronic Commerce Act, 2000.
______________________________ | ______________________________ |
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How it works
Prepare your document, one step at a time.
Answer the questions, choose the download you need, then continue with signing or booking.
Overview
About this document
- 01
What is a consent to release information?
It is a sworn authorization for a holder of your records to share them with a named person or body, with any limits you set.
Holders often require clear, signed authorization before releasing records.
- 02
When you might need one
It authorizes sharing your records.
- You want records released to a lawyer, family member, or organization.
- A holder requires signed consent before releasing your information.
- You must define exactly what may be shared and with whom.
- 03
How to notarize a consent to release personal information in Ontario
Once you have filled in your consent to release personal information and downloaded the PDF, a notary public can witness and notarize your signature so a third party can rely on it.
Minute Notary notarizes your consent to release personal information online by secure video, under Ontario's remote commissioning rules (O. Reg. 431/20), or in person in Ottawa. Bring valid government-issued photo identification.
- Fill in the document online and download a clean, ready-to-sign PDF — free, no account.
- Present valid photo ID; we witness your signature and apply the notary seal.
- Your document is ready to use.
Good to know
Before you fill it in.
Short notes from our notary on this template. Worth a minute before you start.
- 01
Reviewed for use in Ontario by a notary public and commissioner for taking affidavits.
- 02
Fill it in online for free and download a ready-to-sign PDF — no account required.
- 03
Sign in front of the notary, who administers your oath or witnesses your signature and applies the seal.
- 04
Notarize online by video across Ontario, or in person in Ottawa.
Frequently asked
Questions about the Consent to Release Personal Information
- Can I limit what is released?
- Yes. Describe exactly which records may be shared and add any conditions or dates so the holder releases only what you intend.
- Can I cancel it later?
- Yes. It stays in effect until you revoke it in writing; notify the holder if you withdraw consent.
- Can I notarize it online in Ontario?
- Yes. You can complete it online by video under Ontario’s remote commissioning rules, or in person in Ottawa with Minute Notary.
- What should it include?
- The holder, the recipient, the records to be released, and any limits, dates, or conditions.
Keep exploring
Related templates
Other documents for identity & personal status.
- 01Statutory Declaration of Revocation of Authorization
A sworn declaration revoking an authorization or consent you previously gave — used to formally end someone’s authority to act for you. Fill it in online, download a ready-to-sign PDF, and notarize in Ontario.
Fill it out - 02Authorization Letter for Vehicle Pickup
A letter authorizing another person to pick up or take possession of your vehicle — for a dealership, shop, tow yard, or transport. Fill it in online, download a ready-to-sign PDF, and have it notarized in Ontario where required.
Fill it out - 03Mutual Release Agreement
A mutual release in which two parties release each other from claims to settle a dispute. Fill it in online, download a ready-to-sign PDF, and have signatures witnessed in Ontario. Consider legal advice before signing.
Fill it out - 04Custom Affidavit
Write your own affidavit in our free online form when no standard template fits, then swear it before a notary. Start online; notarize by video across Ontario or in person in Ottawa.
Fill it out
Ready to sign?
Ready to create your Consent to Release Personal Information?
Fill it in online, then download a ready-to-sign PDF or an editable Word copy. Use the generated PDF to continue to booking. Not sure what the appointment involves? Read about the Statutory Declarations service first.