Privileged and Confidential Inquiry Form


Homewood Confidential Inquiry Form If you have used Homewood Employee and Family Assistance Program services prior to April 1, 2021 and would like to find out if your information may have been affected by the cyber security incident, please complete the following web form. Prior to using this form, please note the following: To protect your confidentiality, we need to verify your identity before we can release any information This online form is for inquiry regarding your personal information only – you cannot use this form to inquire on behalf of another individual The information collected in this form is strictly for the purpose of verifying your identity, confirming if your personal information may have been affected by this incident and communicating back to you. Once verified, all information is deleted. What happens after I submit this form? Once your information has been verified, we will send you written notification confirming whether or not you were affected within approximately one week. If you would prefer to speak with someone directly, you can call Homewood’s confidential inquiry line at 1-833-787-2862 available Monday to Friday from 8am to 8pm Eastern time. Privacy Homewood Health Inc. is collecting your personal information for the purposes stated above. Once verified, the information that you are providing will be stored in Canada in our own data centers, behind enterprise class firewalls. The data collected in the inquiry form will be temporarily saved in Homewood’s database and once it has fulfilled its purpose, it will be destroyed. Homewood Health uses administrative, physical and technical measures to safeguard your personal information. Are you inquiring about yourself? Yes No

Homewood Confidential Inquiry Form

If you have used Homewood Employee and Family Assistance Program services prior to April 1, 2021 and would like to find out if your information may have been affected by the cyber security incident, please complete the following web form.

Prior to using this form, please note the following:

To protect your confidentiality, we need to verify your identity before we can release any information
This online form is for inquiry regarding your personal information only – you cannot use this form to inquire on behalf of another individual
The information collected in this form is strictly for the purpose of verifying your identity, confirming if your personal information may have been affected by this incident and communicating back to you.
Once verified, all information is deleted.

What happens after I submit this form?

Once your information has been verified, we will send you written notification confirming whether or not you were affected within approximately one week.

If you would prefer to speak with someone directly, you can call Homewood’s confidential inquiry line at 1-833-787-2862 available Monday to Friday from 8am to 8pm Eastern time.

Privacy
Homewood Health Inc. is collecting your personal information for the purposes stated above. Once verified, the information that you are providing will be stored in Canada in our own data centers, behind enterprise class firewalls. The data collected in the inquiry form will be temporarily saved in Homewood’s database and once it has fulfilled its purpose, it will be destroyed. Homewood Health uses administrative, physical and technical measures to safeguard your personal information.

Are you inquiring about yourself?

Yes