I, the undersigned, declare that the above
information provided by me are true to the best of my knowledge and hereby provide my consent to the
Manipal Hospital to provide Medical Care, Treatment, Conduct Investigations and Diagnostic
Procedures necessary for the above mentioned individual by Medical Staff at Manipal Hospital. I,
also understand that Manipal Hospital will not be responsible for any loss, damage or theft of any
Personal Property/Belongings of Me/Patient/Visitors within the Hospital Premises. Including Patients
rooms and Parking area. I agree to follow all the rules and regulations of Hospital and clear all
the expenses incurred for My/Patient treatment on time as per the Terms and Conditions of Manipal
Hospital,
If consent provided on behalf of the patient.
I hereby give my consent and authorize Manipal Hospitals to process,
store,use,disclose my personal or sensitive information/data collected as per Manipal Privacy Policy