Access to Information / Disclosure Form

If you are currently receiving services from CASDSM or have in the past, and would like access to your personal information, please fill our our Access to Information/Disclosure form.

You must attach one copy of valid government issued photo identification along with your request.

Please note, the written consent of any person age 16 years and older is required to release their information and must be included with your request. They can complete the Consent to Disclose Information form and you can attach it to your request.

A person with custody of a child under the age of 16 may request personal information of that child, subject to some exceptions. In some circumstances, you may be asked to provide documents confirming your authority to make the request in place of the child.

"*" indicates required fields

Do you identify as First Nations, Inuit or Métis:
CASDSM continues to be committed to working alongside the First Nations, Inuit, and Métis communities in Ontario, in accordance with the Act Respecting First Nations, Inuit and Métis Children, Youth and Families, to prioritize cultural connection and services for families, children and youth. In following through with child welfare commitments to the Indigenous community we are asking questions about Indigenous heritage to ensure information provided is equitable and culturally sensitive supports are provided.

Purpose of Request:

Please choose one:*

Personal Details

Name*
Date of Birth*
Add Child
If applicable, please list other individuals about whom you are requesting information (Note: the written consent of any person aged 16 years and older is required to release their information and must be included with your request to obtain their information):
First Name
Last Name
Date of Birth (MM/DD/YYYY)
 

Contact Information

Address*
Preferred Phone Number*

Request Details

If possible, please provide additional details regarding the reason for your request as this will assist us to provide you with the information you require.
Additional Information

Please attach information to support your request.

Max. file size: 300 MB.
Max. file size: 300 MB.
Max. file size: 300 MB.
Max. file size: 300 MB.
Confirmation & Consent*
Confirmation & Consent Checkbox 2*
Confirmation & Consent Checkbox 3*
Confirmation & Consent Checkbox 3

Concerned about a child or youth? Call us 24/7 705-566-3113 | 1-877-272-4334 What happens when I call?