Subscission/Sterion Injection General Consent Form

I am asking for medical care and treatment at this facility, and agree to accept services which may diagnose my medical condition, procedures to treat my condition, and routine dental and medical care.

I understand that some of my physicians, nurses, and other healthcare providers may be trainees under the supervision of appropriate personnel, and may participate in my treatment, and I consent to such involvement in my care.

I understand that my agreement to accept these services is called a General Consent, and that it includes any routine procedures or treatments such as blood drawing, physical examination, administration of medications, taking X-rays, use of local anesthesia, and other non-invasive procedures.

I do acknowledge and agree that any amount paid against procedure is nonrefundable as long as the procedure is done in spite of results.

I further acknowledge that results of medical treatments and surgical procedures may not be adequately predicted. Neither the hospital nor the attending medical team can or are allowed to give any guarantee or confirmation of outcomes.

I assume full responsibility for all items of personal property, including but not limited to, eyeglasses, hearing aids, dentures, jewelry, money, and all other valuables. I understand that valuables may be secured in a hospital safe upon my request, and hereby release the hospital of any responsibility for those valuables and items of personal property which are not deposited with the hospital for safekeeping.

I understand that there may be personal costs involved in my treatment as per the UAE laws and regulations.