Please, fill out all fields in the inquiry form to request our services. You may need to check off a consent form upon your agreement.
I hereby acknowledge my full understanding of Love Toronto legal counsel referral service. The service entails Love Toronto referring me to the registered attorneys who are willing to provide legal or non-legal information pertaining to my matters. I understand that by submitting this form, any information I provide here will be read by Love Toronto staff. Regarding these, I hereby acknowledge my understanding that Love Toronto will not share or use any of my shared information on this form with anyone but the referred legal counsel.
I hereby acknowledge that I am signing up for Love Toronto legal counsel referral service out of my own free will and voluntariness to receive all information provided by the referred legal counsels.
I hereby acknowledge that if I were to apply the provided information legally, I will need to consult and retain an attorney on my own to further pursue legal proceedings. In the event of voluntarily applying the provided information, I hereby acknowledge potential legal risks of doing so with my own discretion. If any legal consequences were to arise from my own conduct, I hereby acknowledge that only I will be held liable and I cannot hold Love Toronto, including Love Toronto staff and board members, and/or the referred legal counsel accountable for it.
I hereby acknowledge and agree to not hold Love Toronto and/or the referred legal counsel liable for any legal consequences arising from my own application of the provided information to legal proceedings. I affirm that I am signing this waiver form voluntarily.
I hereby give my permission to provide any needed medical treatment for me through Love Toronto. I specifically give my permission for necessary and emergency care to be given to me by any physicians and other independent healthcare practitioners providing medical or other healthcare and treatment to me through Love Toronto. I attest that I disclosed all my medical conditions. I hereby acknowledge that any potential risks of personal injury arising from any needed medical treatment. I hereby assume all such risks. I hereby release and agree to hold harmless Love Toronto, its Board of Trustees, any medical treatment providers from all claims, actions, damages and liabilities for personal injury or damage relating to or arising out of any treatment or counselling activity except in the event personal injury has been caused by the gross negligence or willful misconduct of any physicians, other independent healthcare practitioners, LOVE TORONTO, its employees, agents, volunteers, members, officers or directors. I affirm that I am signing this waiver form voluntarily and was advised to seek independent legal advice before I sign this, but I decline to do so.
(“Agreement”) is entered into by and between patients and volunteer physicians at Love Toronto clinic (collectively, the “Parties”). Governing Law The Parties hereby agree that: a) all aspects of the relationship between I and volunteer physicians at Love Toronto clinic (as well as her/his agents, delegates, employees, and any physicians and other independent healthcare practitioners providing medical or other healthcare and treatment to patients, or in association with patients, including without limitation any medical or other healthcare and treatment provided to me, and b) the resolution of any and all disputes arising from or in connection with that relationship, including any disputes arising under or in connection with this Agreement, shall be governed by and construed in accordance with the laws of the province or territory of Ontario (other than conflict of laws rules) and the laws of Canada applicable therein. Exclusive Jurisdiction The Parties hereby acknowledge that the medical or other healthcare and treatment received by patients from volunteer physicians at Love Toronto clinic will be provided in the province or territory of Ontario, and that the Courts of Ontario shall have exclusive jurisdiction to hear any complaint, demand, claim, proceeding or cause of action, whatsoever arising from or in connection with that medical or other healthcare and treatment, or from any other aspect of the relationship between patients and volunteer physicians at Love Toronto clinic.
I hereby acknowledge that Love Toronto does not provide psychotherapeutic counselling service directly to clients, but it merely provides referral to the registered psychotherapists of Ontario. I understand that this service is offered with a fee under the regulation of College of Psychotherapists of Ontario. I hereby acknowledge that I am signing up for Love Toronto psychotherapeutic counseling referral service out of my own free will and voluntariness. I hereby acknowledge my understanding that all client information is strictly held confidential, and no information will be released to a third party without the client’s prior written authorization, but exceptions to confidentiality may arise in legal and/or ethically obligated situations between the client and psychotherapist. I hereby acknowledge my understanding that the psychotherapist will follow their own policy and procedure regarding when they may be required to take additional steps to ensure safety. I hereby acknowledge and agree to not hold Love Toronto staffs liable for any consequences arising from my own counselling sessions. I affirm that I am signing this waiver form voluntarily.