Non-Objection Declaration
I the undersigned have read and understood this letter and agree to give full authority to the Clinic and it’s responsible assigned physician & medical staff to perform diagnostic procedures as well as therapeutic procedures necessary in the course of management of my particular case.
I here by declare to the clinic my full responsibility and agree not to hold the clinic or any of the management or health and medical staff questionable or bring them forward in any trail related to my treatment.
Date
Patient Name
Signature ________________________
Person Responsible ( Guardian )
In Witness:____________
