Patient Declaration

All information collected by this practice will be used for providing healthcare. Collection and utilization and storage of this information will be compliant with the 2001 Health Records Act. I consent to Mr. Yagnesh Vellore collecting and storing my health information.

I also acknowledge that if I do not have the appropriate private insurance cover, I will need to obtain any further medical or surgical treatment through the public health system, and it is my responsibility to access this through my General Practitioner.