I am asking for , medical care and treatment at FertiClinic and agree to accept services which diagnose my medical condition, procedures to treat my condition and medical care.

• I understand that these services will be provided to me by healthcare professionals.
• I understand that my agreement to accept these services is called General Consent and that it includes any routine procedure(s) or treatment(s) such as blood drawing, physical examination, administration of medication(s), taking x-rays, ultrasounds, use of local anesthesia, and other non- invasive procedures.
• I do acknowledge that different declarations may be needed for some specific diagnostic and surgical procedures.
• I further acknowledge that results of medical treatments and surgical procedures may not be adequately predicted. Neither the center nor the attending medical team can or are allowed to give any guarantee or confirmation of outcomes.
• I am aware that FertiClinic is obliged to share my medical information, or to release all or part of my medical information to Health Authorities for any mandatory reporting as may be necessary.
• I understand that my agreement to accept these services will remain in effect unless I say that I no longer want these services.
• 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 during my stay at the premises of FertiClinic.
• I accept the responsibility for all those charges tha are not paid by my insurance.
• I have been informed about my rights responsibilities as a patient at FertiClinic