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Across from the Delta Hotel on Erb St. in Waterloo, Ontario

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Privacy Policy

Privacy Policy

Dr. Pierce, Dr. Ellison and Dr. Clayfield, Optometrists

Privacy of personal information is an important principle to Dr. Pierce, Dr. Ellison and Dr. Clayfield, Optometrists. We are committed to collecting, using and disclosing personal information responsibly and only to the extent necessary for the optometric services and products that we provide. We also try to be open and transparent as to how we handle personal information. This document describes our privacy policies.




We are required to comply with the terms of this privacy policy while it is in effect. We reserve the right to modify the policy at any time and the revised privacy policy will apply to all protected health information that we currently have as well as to information that we may generate in the future. This policy will be in effect from January 1, 2004 until the date an amended policy is published. If we change the privacy policy, we will post the amendments in our office and have copies available.


What is Personal Information?

Personal information is information about an identifiable individual. Personal information includes information that relates to their personal characteristics (e.g., gender, age, income, home address or phone number, ethnic background, family status), their health (e.g., health history, health conditions, health services received by them) or their activities and views (e.g., religion, politics, opinions expressed by an individual, an opinion or evaluation of an individual). Personal information is to be contrasted with business information (e.g., an individual’s business address and telephone number), which is not protected by privacy legislation.


Who We Are

Dr. Pierce, Dr. Ellison and Dr. Clayfield Optometrists includes any optometrist or health care professional, all employees, staff and student trainees authorized to collect, use or disclose personal information. We use a number of consultants and agencies that may, in the course of their duties, have limited access to personal information we hold. These include, but are not limited to, computer consultants, office security and maintenance, bookkeepers and accountants, temporary workers to cover holidays, credit card companies, collection agencies, website managers, cleaners and lawyers. We restrict their access to any personal information we hold as much as is reasonably possible. We also have their assurance that they follow appropriate privacy principles.

We Collect Personal Information: Primary Purposes


About Patients

Dr. Pierce, Dr. Ellison and Dr. Clayfield Optometrists collects, uses and discloses personal information in order to serve our patients. For our patients, the primary purpose for collecting personal information is to provide optometric services. For example, we collect information about a patient’s health history, including their family history, physical condition and function, and social situation in order to help us assess what their eye care needs are, to advise them of their options and then to provide the eye care they choose to have. We may communicate this information to other regulated health practitioners, technicians, or individuals authorized to work in our practice as part of a patient’s continuing care. A second primary purpose is to obtain a baseline of health and social information so that in providing ongoing health services we can identify changes that are occurring over time. It would be rare for us to collect information without the patient’s implied consent, but this might occur in an emergency (e.g., the patient cannot communicate) or where we believe the patient would consent if asked and it is impractical to obtain consent (e.g., a family member passing a message on from our patient where we have no reason to believe that the message is not genuine).


About Members of the General Public

For members of the general public, our primary purposes for collecting personal information are to make them aware of optometry services in general or our practice in particular, or to provide notice of special events (e.g., a seminar or vision screening). For example, while we try to use work contact information whenever possible, we might collect home addresses, fax numbers and e-mail addresses but not without consent.

About Contract Staff, Volunteers and Students

For people who are contracted to do work for us (e.g., temporary workers), our primary purpose for collecting personal information is to ensure we can contact them in the future (e.g., for new assignments) and for necessary work-related communication (e.g., sending out paycheques, year-end tax receipts). Examples of the type of personal information we collect for those purposes include home addresses and telephone numbers. It is rare for us to collect such information without prior consent, but it might happen in the case of a health emergency (e.g., a SARS outbreak) or to investigate a possible breach of law (e.g., if a theft were to occur in the office). If contract staff, volunteers or students wish a letter of reference or an evaluation, we will collect information about their work related performance and provide a report as authorized by them.


We Collect Personal Information: Related and Secondary Purposes


Like most organizations, we also collect, use and disclose information for purposes related to or secondary to our primary purposes. The most common examples of our related and secondary purposes are as follows:


q To invoice patients for optometric services, products or treatments that were not paid for at the time the service was provided, to process credit card payments or to collect unpaid accounts either ourselves or through a collection agency or attorney.


q When the cost of some optometric services, products or treatments provided by the practice to patients is paid for by third parties (e.g., OHIP, WSIB, private insurance, Assistive Devices Program, and various social assistance programs). These third-party payers often have your consent or legislative authority to direct us to collect and disclose to them certain information in order to demonstrate patient entitlement to this funding.


q To advise patients, by telephone, mail or e-mail, that their vision and eye care needs or treatment should be reviewed (e.g., to schedule their next appointment, to ensure that their eye glasses and/or contact lenses are still functioning properly and appropriate for their current needs and to consider modifications or replacement).


q To advise patients, prospective patients, and others of special events or opportunities (e.g., a seminar, development of a new service, arrival of a new product) that we have available.


q Dr. Pierce, Dr. Ellison and Dr. Clayfield Optometrists reviews patient and other files for the purpose of administration, business planning and ensuring that we provide high quality services, including assessing the performance of our staff. In addition, external consultants (e.g., auditors, lawyers, practice consultants, quality assurance programs) may, on our behalf, do audits and continuing quality improvement reviews of our practice, including reviewing patient files and interviewing our staff. In rare cases, our practice or our consultants may make inquiries to verify that the information we have about you is accurate.


q Optometrists are regulated by the
College of
Optometrists of
Ontario who may inspect our records and interview our staff as a part of their regulatory activities in the public interest. In addition, as professionals, we report serious misconduct, incompetence or incapacity of other practitioners, whether they belong to other organizations or our own. Also, our practice believes that it should report information suggesting serious illegal behaviour to the authorities. External regulators have their own strict privacy obligations. Sometimes these reports include personal information about our patients, or other individuals, to support the concern (e.g., improper services). Also, like all organizations, various government agencies (e.g., Canada Customs and Revenue Agency, Information and Privacy Commissioner, Human Rights Commission, etc.) have the authority to review our files and interview our staff as a part of their mandates. In these circumstances, we may consult with professionals (e.g., lawyers, accountants) who will investigate the matter and report back to us.


q Patients or other individuals we deal with may have questions about our products or services after they have been received. We also provide ongoing optometric services for many of our patients over a period of months or years for which our previous records are helpful. We retain our patient information for a minimum of 10 years after the last contact to enable us to respond to those questions and provide these services (our regulatory College also requires us to retain our patient records).


q If Dr. Pierce, Dr. Ellison and Dr. Clayfield, Optometrists or its assets were to be sold, the prospective purchaser would want to conduct a “due diligence” review of the practice records to ensure that it is a viable business that has been honestly portrayed to the prospective purchaser. This due diligence may involve some review that may include releasing personal information. The prospective purchaser would not be allowed to remove or record personal information and, before being provided a review of the clinical files and records, the prospective purchaser must provide a written promise to keep all personal information confidential. Only reputable purchasers who have already agreed to purchase the practice or its assets would be provided, at closing, complete access to personal information. The purchaser would be required to maintain the same principles of privacy as established under the present privacy legislation.


You can choose not to be part of some of these related or secondary purposes (e.g., by declining to receive notice of special events or opportunities, by paying for your services in advance). We do not, however, have much choice about some of these related or secondary purposes (e.g., external regulation).


Protecting Personal Information


We understand the importance of protecting personal information. For that reason, we have taken the following steps:

q Employees, including temporary staff, are trained to collect, use and disclose personal information only as necessary to fulfill their duties and in accordance with our privacy policy.

q Paper information is either under supervision or secured in a locked or restricted area.

q Electronic hardware is either under supervision or secured in a locked or restricted area at all times. In addition, passwords are used on computers.

q Paper information is transmitted through sealed, addressed envelopes or boxes by reputable companies or collected by the patient who asks for the information

q Electronic information is transmitted either through a direct line or is anonymized or encrypted.

q Verbal personal information is collected and used in such a manner that the information is not overheard by persons other than the patient or practice members.

q External consultants and agencies with access to personal information must enter into privacy agreements with us.


Retention and Destruction of Personal Information


We need to retain personal information for some time to ensure that we can answer any questions you might have about the services we provided to you and for our own accountability to external regulatory bodies.

In compliance with the requirements of other legislation, we keep our patient files and records for a minimum of 10 years. We keep any personal information relating to our general correspondence (i.e., with people who are not patients), newsletters, seminars and marketing activities for about 6 months after the newsletter ceases publication or a seminar or marketing activity is over. You can ask us, in writing, to restrict our uses and disclosures of personal information at any time. We will also discontinue to use or to disclose your personal information after a written revocation of your implied or informed consent is received, unless we have already acted in reliance upon this consent.

We destroy paper files containing personal information by shredding. We destroy electronic information by deleting it and, when the hardware is discarded, we ensure that information on the hard drive is destroyed. Alternatively, we may send some or the entire patient file to our patient.

You Can Look at Your Information

With rare exceptions, you have the right to see what personal information we hold about you. Often all you have to do is ask. We can help you identify what records we might have about you. We will also try to help you understand any information you do not understand (e.g., short forms, technical language, etc.). We will need to confirm your identity, if we do not know you, before providing you with this access. We reserve the right to charge a nominal fee for such requests.

We may ask you to put your request in writing. If we cannot give you access, we will notify you within 30 days if at all possible, and provide the reason, as best we can, as to why we cannot give you access.

If you believe there is a mistake in the information we have about you, you have the right to ask for it to be corrected. This applies to factual information and not to any professional opinions we may have formed. We may ask you to provide documentation that our files are incorrect. Where a mistake has been made, we will make the correction and notify anyone to whom we sent this information. If we do not agree that a mistake has been made, we will include in our file a brief statement from you on the point and we will forward that statement to anyone else who received the earlier information.


Do You Have a Question?

Our Information Officer, Dr. Patricia Ellison, can be reached at:

107 Erb St W. Waterloo
N2L 1T6


She will attempt to answer any questions or concerns you might have.

If you wish to make a formal complaint about our privacy practices or the application of those practices, you may make it in writing to our Information Officer. She will acknowledge receipt of your complaint, ensure that it is investigated promptly and that you are provided with a formal decision and reasons in writing.

If you have a concern about the professionalism or competence of our services or the mental or physical capacity of any of our professional staff we would ask you to discuss those concerns with us. However, if we cannot satisfy your concerns, you are entitled to file a complaint with our regulatory body by writing to or communicating with:

College of

6 Crescent Road, 2nd Floor

Toronto, Ontario
M4W 1T1

Telephone (416) 962 4071, Toll Free (888) 825 2554, Fax (416) 962 4073


Web site:


This policy is made under the Personal Information Protection and Electronic Documents Act. That is a complex Act and provides some additional exceptions to the privacy principles that are too detailed to set out here. There are some rare exceptions to the commitments set out above.

For more general inquiries, the Information and Privacy Commissioner of oversees the administration of the privacy legislation in the private sector. The Commissioner also acts as a kind of ombudsman for privacy disputes. The Information and Privacy Commissioner can be reached at:


112 Kent Street

Ottawa, Ontario | K1A 1H3

Phone (613) 995-8210 | Toll-free 1-800-282-1376

Fax (613) 947-6850 | TTY (613) 992-9190


Web site: www.privcom.gc.

Patient Privacy Protection Form

Note to Patient: We want your informed consent. This means that we want you to understand the services we will provide to you, and what we do with personal information we obtain about you. If you have a question on any of this, please ask.




I understand that to provide me with optometric services and products Dr. Pierce, Dr. Ellison and Dr. Clayfield Optometrists will collect some personal information about me (e.g. home telephone number, address, OHIP number, medications used).



I have reviewed Dr Pierce, Dr Ellison and Dr. Clayfield Optometrists’ Privacy Policy with respect to the collection, use and disclosure of personal information, steps taken to protect the information and my right to review my personal information. I understand how the Privacy Policy applies to me. I have been given a chance to ask any questions I have about the Privacy Policy and they have been answered to my satisfaction.



I understand that I may receive without request, some of the following notices and information. I have checked below the specific information which I consent to receive from Dr. Pierce, Dr. Ellison and Dr. Clayfield Optometrists.



q Reminder notices for another eye examination AND any other newsletters or informational mailings from Dr. Pierce, Dr. Ellison and Dr. Clayfield Optometrists





q Reminder notices for another eye examination ONLY from Dr. Pierce, Dr Ellison and Dr. Clayfield, Optometrists




q I do NOT wish to receive ANY information whatsoever from Dr. Pierce, Dr. Ellison and Dr. Clayfield Optometrists



I understand that, as explained in the Privacy Policy, there are some rare exceptions to these commitments.



I agree to Dr. Pierce, Dr. Ellison and Dr. Clayfield, Optometrists collecting, using and disclosing personal information about me as set out above and in Dr. Pierce, Dr. Ellison and Dr. Clayfield Optometrists’ Privacy Policy.







SIGNATURE: __________________________________ DATE: ___________________















NOTES MADE BY Dr. Pierce, Dr. Ellison and Dr. Clayfield, Optometrists






Pierce Family Vision is now open for routine examinations, frame selections and adjustments by appointment. We have taken great care to keep our patients and staff safe in these extraordinary times. Please give us a call at 519-886-4170 for more information. For those wanting advice but not ready to visit the office yet, we are offering online tele-optometry consultations. Stay safe and we hope to see you soon!