Forms
Consent forms
Consent to disclose personal information
The consent to disclose personal information form gives Alberta Blue Cross® permission to release relevant confidential personal information about an individual.
If you have any questions about filling in this form, or our policies, call 1-855-519-8002 or email MLAQ@ab.bluecross.ca.
Consent to authorize inquiry to Alberta Blue Cross® by a constituency office
The Authorized Inquiry to Alberta Blue Cross® by a Constituency Office consent form gives Alberta Blue Cross® permission to release relevant confidential information about an individual to constituency office staff.
If you have any questions about filling in this form, or our policies, call 1-855-519-8002 or email MLAQ@ab.bluecross.ca.
When handling a request for assistance from a constituency office, we will often work directly with the constituent through our customer services department. At times—although rarely—the constituent may want a constituency assistant’s direct involvement, in which case we need an Alberta Blue Cross® consent form signed by the plan member so that we can release personal information. Normally, we are able to help constituents with their inquiries without the need for a consent form.
We realize that some individuals with limited mobility or transportation may not be able to get a signed copy of the consent form to their MLA’s office. We will make every effort to be accommodating in these situations.
