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Potability of Water Release Form The Ministry of Health and Long-Term Care, Laboratory Services Branch, has traditionally provided a bacteriological testing service to those residents of Ontario who must rely on well – water, as they do not have access to a treated municipal drinking water supply. This Service will continue, but, Public Health Laboratories will not process water samples submitted under the name of a Real Estate Company or other Commercial Firm unless arrangements have been made through the local Medical Officer of Health. The ensure confidentiality, laboratory results will be issued only to the individual whose name and return address appear on the data sheet, unless the laboratory received written permission from that individual to release the results to another designated person. I _________________________________________, hereby authorize the Public Health Laboratory to release information regarding the well water taken from my property located at To ________________________________________, of Signature of Owner: __________________________________________________ Date: ________________________________________________________
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