I here authorized Saudi German Hospital to carry out medical examination, investigation, medical treatment, and diagnostic procedures during the course of my care be deemed advisable or necessary with no guarantees about the final results the treatment. I consent to pay all charges of the services that will be rendered to me according to hospital regular price list. I confirm that I am the patient (or the Patient's parent or guardian if the patient is under 18 years of age), hereby consent to and authorize the medical provider, agents, health professional or other relevant administrative establishment to provide and discuss with me and/or any of my family members about any health/treatment/billing details, medical records or discharge arrangements (past or present) with and to the insure and/or Third Party Administrator. I also understand that the medical expenses coverage is as per stipulated terms and conditions in insurance policy and if there is any excess, charges, expenses not covered in the policy, I hereby consent to send my medical / lab/ radiology reports to the mobile number or the e-mail address which I have provided upon registration. I hereby agree that it will be paid/bare by me/my dependents/or others. I agree that a copy of this consent shall have the validity of the original. I agree that healthcare provider(s) involved in my care at this facility will access my health information through the Health Information Exchange System (NABIDH) in accordance with the Laws of the United Arab Emirates, Emirate of Dubai Legislation and Dubai Health Authority Policies. I agree to deal with all medical education workforce including trainees, students, and volunteers, as long as it is under direct supervision of the treating healthcare practitioners including their presence for observation during consultation, treatment or surgical intervention. I received a copy of Bill of Patient & Family Rights and Responsibilities and explained by the hospital staff.

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