I/We give our fullest consent voluntarily to The Assistance to take normal care of my/our Elderly Member/s as detailed in this Form for his/her/their wellbeing during usual health condition as well as to facilitate medical assistance through a physician of my/our choice when required by way of providing medical treatment during general or emergency situation, if required for assisting in hospitalization as directed by my/our physician or as per my/our suggestion. The entire cost of such medical treatment at home by the physician of my/our choice and/or on hospitalization of our choice till discharge of the Elderly Member/s shall be fully borne by us other than the complimentary services that are provided by The Assistance as mentioned in this leaflet.
I/We fully understand, say and admit it clearly herein that The Assistance shall NO WAY BE HELD RESPONSIBLE for the medical treatments provided and/or for the outcomes from such treatments and/or for any medical negligence and/or for any other reasons while treating and/or attending any such general or emergency medical conditions and treatments undertaken upon the Elderly Member/s either at home or in my/our preferred hospital/nursing home/institute as directed by me/us or by any physician of my/our choice at home or in any hospital/nursing home/institute of my/our choice.
I/We willingly agree to accept ALL the terms and conditions of The Assistance as mentioned hereinabove as also annexed in separate sheet/s after fully understanding all its meaning and purport and thereafter put my/our signature/s herein below as an indication of my/our voluntary acceptance.