Patient Registration

Male
Female

Mobile: UAE Number: 55XXXXXX ISD Number: CountrycodeMobilenumber(No space in between)

Passport / Emirates Image Upload: File must be an image & less than 2 MB

GENERAL CONSENT
I here authorized Saudi German Hospital to carry out medical examination, investigation, medical treatment, and diagnostic procedures during the course of my care be deemed advisable or necessary with no guarantees about the final results the treatment.I consent to pay all charges of the services that will be rendered to me according to hospital regular price list. I confirm that I am the patient(or the Patient’s parent or guardian if the patient is under 18 years of age), I hereby consent to and authorize the medical provider, agents, health proffessional or other relevant administrative establishment to provide and discuss any health / treatment / billing details, medical records or discharge arrangements (past or present) with and to the insure and/ or Third Party Administrator about me and/ or any of my family members. I also understand that the medical expenses coverage is as per stipulated terms and conditions in insurance policy and if there is any excess, charges, expenses not coverd in the policy, I hereby agree that it will be paid / bare by me/ my dependents / or others.I agree that a copy of this consent shall have the validity of the original. I received a copy of Bill of Patient &Family Rights and Responsibilities and explained by the hospital staff.