I hereby authorize Kai Life Clinic the performance of such appropriately indicated physical examinations, and other routine diagnostic procedures and treatments as my physician or others of the Clinic practitioner consider to be necessary or appropriate for the purpose of diagnosis of the patient's condition. I understand that the nature of and the need for each procedure and treatment will be explained to me beforehand, and that I am free to refuse anyone or all procedures or treatments if I so choose.

I consent to the present and future prescription and/or administration of medicines or drugs be deemed necessary by the patient's physician or others of the Clinic practitioner in the course of my diagnosis and treatment with the understanding that the nature of and the need for such medicines or drugs will be explained to me beforehand, and that I shall always be free to refuse each and all of them if I so choose.

I understand that the explanation which will be given to me of the nature, intended purpose, and the reasonable foreseeable risks, consequences, complications, benefits and alternatives of the examination(s), procedure(s) or treatment(s) which may be performed or used in the course of diagnosing or treating my condition will not be exhaustive and that other risks and complications may arise but the likelihood of their occurring is not reasonably foreseeable. I have been advised that if I desire a more detailed explanation prior to my consent such explanation will be given to me.

I acknowledge that I have received no warranties or assurances with respect to any benefits which are hoped to be realized, or consequences which may result, from any of the examination(s), procedure(s) or treatment(s) which may be performed or used. I understand that the practice of medicine is not an exact science, and that diagnosis and treatment may involve risks of injury and even death.

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 of Emirates, Emirate of Dubai Legislation and Dubai Health Authority Policies.

I acknowledge the fact that Kai Life Clinic has the authority to dispose taken for laboratory or pathological examination and I consent to same. I hereby authorize the clinic and authorized persons to review and/ or release my personal information to other healthcare providers for better treatment.

I hereby authorize and direct the clinic or authorized personnel to provide copies of all my medical records to government agencies, insurance companies, my family and relatives and others who are financially liable for my treatment and medical care, all information needed to substantiate payment for such treatment and medical care.

I acknowledge receiving the patient’s guide/ handouts of patient rights and responsibilities. I consent to receive text messages or emails from Kai Life Clinic.

It is understood that during my treatment we are not supposed to bring any valuables to the clinic and Kai Life Clinic and authorized personnel shall not be held responsible or liable for any loss or damage of these items.

I understand that Kai Life Clinic will collect and store information relevant to my health together with other information for the purposes of administration, financial matters, including personal contact details (personal information).

I also authorize Kai Life Clinic to utilize my medical information, or to release all or part of my medical information to other health care providers consulted by my physician or the clinic, as may be necessary. Sharing Personal information with:

• Other healthcare providers for the purpose of patient care.
• My insurer, other third party payers, agents an or consultants for the purpose of reviewing, investigating or processing any relevant claims for reimbursement and related matters and
• Any relevant government authority in accordance with statutory obligations.

Our physicians may recommend that you are referred to another of our specialist or those affiliated with us. When a referral is recommended, we ensure that the referral is offered on the grounds of clinical need and in the best interest of the patients. You may not wish to take up the offer of a referral and you may seek the same treatment from a physician of your choice.

I acknowledge that I have read this document in its entirety and that I fully understand it prior to my signing. I understand that I am to make any inquiries regarding any aspect of my diagnosis or treatment which I do not understand. I represent to physician that I am eligible to give this consent.

*Note: If the patient is under 18 years of age, the permission of the patient's parent or legal guardian must be obtained, unless the patient is married or is the parent of a child.