| I here by give consent authorization to being examined in the OPD by the doctors appointed in the OPD.I understand the Doctor will be assisted by other health care professionals & such others he/she feels necessary. I agree with their participation in my care. |
| I gave consent to carry out necessary tests or investigations and I am willing to pay all the charges for the treatment. I am fully aware that treatment is being performed in good faith & that no guarantee or assurance has been given for the results to be obtained.I am responsible for my personal belongings and I do not hold doctors/staff hospital responsible in case of any loss of personal belongings. |
| I am aware that photography/ videography/ Audio recording in hospital premises is strictly prohibited. |
| I am aware that smoking and consumption of alcohol is strictly prohibited. |
| I have read this consent and/or it has been read over to me and explained to me in the language that I understand. |
| To attest my consent I hereby affix my signature/left hand thumb Impression voluntarily. |
Signature/Thumb Impression of Patient/ Relative |