Consent Form for Information Sharing

This consent form authorizes the Fair Registration Practices Office (FRPO) to share information related to your request for review of a regulatory body's registration decision for the purposes of assessment and resolution, in compliance with privacy legislation.

Personal Details:(Required)

Compliance Concerns

Signature
To sign your name, use your finger, mouse or other compatible input device inside the dotted box. To start signing, press or click, hold and move. To stop signing, lift or release. To clear the signature, press or click the arrows icon in the bottom right corner.
Date(Required)