Medical Consent

MEDICAL CONSENT FORM

I hereby consent to receive medical care, diagnosis, treatment and any other health-related care at Sugar&Heart Clinic at the hands of professionals engaged by Banting Healthcare Private Limited. I understand that as part of my care, I may be required to undergo diagnostic procedures, including but not limited to ____________, and be administered medication and/or vaccines.

I understand that the science of medicine is not fool-proof and there may be risks associated with the care that is offered to me. I acknowledge that no guarantees or promises have been made to me with respect to the care or results of care (including diagnostic test) that is offered to me.

I further understand that I have the ability to consult my treating physician at any time regarding the care will be offered to me, and can seek information regarding the nature of my medication, how it will be administered, the alternatives available, the associated risks and known side-effects.

I undertake that I will not withhold any relevant information from my treating physician.

Waiver of Liability

I hereby agree to waive any and all claims I, or anyone claiming through me or on my behalf, may have now and/ or in the future against Banting Healthcare Pvt. Ltd. and/or its shareholders, directors, officers, agents, independent contractors and employees, and release them from all liabilities including for injury or death arising out of or resulting due to services provided to me, including by way of treatment, diagnostic tests, medication, administration of medication and rehabilitation.