The College of Physicians and Surgeons of Newfoundland and Labrador regulates the practice of medicine in the public interest.
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I, the undersigned, hereby consent and authorize the release of information contained in any health records about myself (including, but not limited to, hospital and doctor's office records, pharmaceutical records, and patient billing information) to the College of Physicians and Surgeons of Newfoundland and Labrador for the purpose of investigating my complaint against a physician.