Consent Form HomeConsent Form Please complete for Form Below +91 9632 345 533 care@hospykare.com First Name (As per passport) Last Name (As per passport) Address1 Address 2 City Eircode Phone Email 2. What is your Date of Birth? 3. Who was the first person you were in contact with? 4. Where did you hear about us? 5. What Treatment do you require? 6. Please give as much information about the treatment required as possible. 7. I consent to allow HospyKare to share Records and Data with other hospitals within the HospyKare network of hospitals. We send records and data to hospitals which we have agreed upon with your consent. We will confirm this with you before travelling. Please call us at any time if you have any questions about how we use your data to communicate with our hospital network. Yes No 8. I have read and agree to the Privacy Policy and Terms of Use. Our privacy policy and Terms of use are necessary in order to use our website and abide by laws and regulations in India. Yes No 9. I consent to allow HospyKare to discuss my treatment plan with my GP & Hospitals.We will contact your GP in order to receive your medical history or if required your referral letter from your GP. We always send your medical translation from our partner hospitals to your GP after you have flown home for follow up care. Yes No 10. I consent to allow HospyKare to contact me by phone, email, SMS and WhatsApp, Botim etc.We will be in contact with you every step of the way usually by emails, calling and some automated text messages to discuss appointment times, to explain some processes etc. Yes No Sumbit
