Program Agreement and Consent Form

By signing this form,

  • I agree to the Terms of Service set out at or in the documents already provided to me titled “Terms of Service (Canada)”
  • I consent to Newtopia Inc., its workforce, subsidiaries, subcontractors, agents and affiliated entities (collectively, “Newtopia”) collecting, using and disclosing my personal information as described the Newtopia Privacy Policy (Canada) at or in the documents already provided to me titled “Privacy Policy (Canada)” (the “Privacy Policy”)
  • I consent to Eastern Health providing to Newtopia, and Newtopia collecting, using and disclosing in accordance with the Privacy Policy, personal health information about me, including without limitation my diagnosis and blood sugar

I understand that:

  • I can revoke my consent to the Privacy Policy at any time by writing to Newtopia at I understand that my revocation will not be effective for information already collected, used and disclosed in reliance on my earlier consent.
  • I may will not be able to participate in the Newtopia Program if I do not sign this agreement and consent or later revoke my consent.
  • I may obtain a copy of this form to keep for my records, by requesting a copy from .