Indus International Medical Tourism Inquiry Consent and Acknowledgment
Introduction
This Consent and Acknowledgment is intended to ensure that patients and their representatives clearly understand the role of Indus International Medical Tourism before submitting medical information, requesting treatment quotations, seeking medical opinions, or making travel arrangements.
By proceeding with an inquiry, submitting documents, or using our services, you acknowledge that you have read, understood, and accepted the terms outlined below.
Patient Information
Patient Full Name: _______________________
Date of Birth: _______________________
Country of Residence: _______________________
Phone Number: _______________________
Email Address: _______________________
Patient Representative (if applicable): _______________________
Relationship to Patient: _______________________
Date: _______________________
Inquiry Reference Number: _______________________
Purpose of This Consent
This document confirms that you have been informed about:
The coordination and facilitation role of Indus International Medical Tourism.
The independent role of hospitals, doctors, and healthcare providers.
Your responsibilities as a patient or authorized representative.
The limitations of the services provided by Indus International.
Nature of Our Services
Indus International Medical Tourism acts solely as a medical travel facilitator and patient coordinator.
We are not a hospital, clinic, physician practice, diagnostic center, emergency service, nursing service, or healthcare provider.
Our services may include:
Collecting inquiry information and medical records for review by hospitals and specialists.
Assisting patients in identifying suitable hospitals, doctors, and treatment destinations.
Coordinating appointments, online consultations, second opinions, and treatment quotations.
Providing assistance with visa support documentation, travel planning, airport transfers, accommodation arrangements, language support, and other non-clinical travel services.
Facilitating communication between patients and healthcare providers before, during, and after treatment when requested.
What Indus International Does Not Do
Indus International does not provide:
Medical advice
Medical diagnosis
Prescriptions
Treatment recommendations
Surgical procedures
Nursing care
Emergency medical services
Rehabilitation services
Clinical decision-making
Any information provided by Indus International is for administrative and coordination purposes only and should never be considered medical advice.
Submitting an inquiry, sharing medical records, or communicating with Indus International does not create a doctor-patient relationship between you and Indus International or any of its employees, representatives, or partners.
Role of Hospitals and Treating Doctors
All medical decisions are made exclusively by the treating hospital and licensed healthcare professionals.
Hospitals and doctors are solely responsible for:
Reviewing medical records and assessing suitability for treatment.
Determining required tests, procedures, medications, surgeries, implants, rehabilitation, or intensive care.
Explaining treatment options, benefits, limitations, risks, and alternatives.
Obtaining medical consent for procedures and treatments.
Delivering all medical care and patient monitoring.
Managing complications, emergencies, revisions, and follow-up treatment.
Maintaining medical records and issuing reports, prescriptions, and discharge summaries.
Patient Responsibilities
By proceeding, you agree to:
Provide complete, accurate, and truthful medical and personal information.
Disclose relevant medical history, medications, allergies, previous procedures, and existing health conditions.
Submit all available reports, scans, laboratory results, and physician notes relevant to your inquiry.
Seek clarification directly from treating doctors regarding medical advice, treatment risks, and expected outcomes.
Carefully review all hospital quotations, treatment plans, travel documents, and visa requirements.
Consult your local healthcare provider before traveling for treatment.
Arrange adequate financial resources, insurance coverage, and contingency funds where appropriate.
Follow the instructions provided by hospitals, physicians, airlines, immigration authorities, and other relevant organizations.
Maintain custody of personal documents including passports, visas, prescriptions, and medical records.
Treatment Costs and Financial Understanding
Any treatment estimate, package price, or quotation provided through Indus International is based on information available at the time of inquiry.
Actual costs may vary due to factors including:
Additional diagnostic tests
Changes in treatment plans
Medical complications
Length of hospital stay
Intensive care requirements
Implant or device selection
Currency fluctuations
Hospital pricing updates
Indus International cannot guarantee final treatment costs and is not responsible for additional charges imposed by hospitals, doctors, laboratories, pharmacies, hotels, airlines, insurance providers, government agencies, or other third-party service providers.
Travel, Accommodation, and Support Services
Indus International may assist with:
Visa support documentation
Flight planning
Airport transfers
Accommodation arrangements
Language assistance
Dietary and cultural preferences
However, we do not control or guarantee:
Visa approvals
Airline schedules
Hotel availability
Transportation services
Government regulations
Weather conditions
Third-party service quality
Final responsibility for travel decisions and associated risks remains with the patient.
No Guarantee of Outcome
Indus International does not guarantee:
Treatment success
Medical outcomes
Recovery timelines
Cosmetic or functional results
Absence of complications
Visa approval
Travel clearance
Availability of specific doctors or treatment dates
Any information regarding hospitals, physicians, treatment options, or expected outcomes is provided for informational purposes only and should not be interpreted as a promise, warranty, or guarantee.
Medical Risks and Emergencies
The patient acknowledges that medical travel may involve risks, including:
Travel-related health complications
Treatment complications
Infections
Unexpected hospital stays
Additional procedures
Intensive care requirements
Delayed recovery
Extended travel arrangements
In emergency situations, all medical decisions will be made by the treating hospital, licensed physicians, and emergency healthcare providers.
Indus International does not provide emergency medical care.
Privacy and Information Sharing Consent
By submitting an inquiry, you authorize Indus International to collect, store, use, and share relevant personal and medical information for the purpose of treatment coordination and medical travel assistance.
Your information may be shared with:
Hospitals
Doctors and specialists
Diagnostic centers
Insurance providers
Embassies and visa authorities
Travel coordinators
Accommodation providers
Information will be shared only when reasonably necessary to facilitate your inquiry, treatment planning, or travel arrangements.
Additional consent may be required directly by healthcare providers before treatment or medical review can proceed.
Independent Decision-Making
The patient acknowledges that all final decisions regarding:
Selection of country
Selection of hospital
Selection of physician
Acceptance or rejection of treatment
Travel arrangements
Medical procedures
remain solely with the patient or the patient’s authorized representative.
Patients are encouraged to discuss proposed treatment and travel plans with their local healthcare providers before making any final decision.
Patient Acknowledgment
By checking the acceptance box, submitting an inquiry, or signing this document, I confirm that:
☐ I understand that Indus International acts solely as a medical tourism facilitator and coordinator.
☐ I understand that Indus International does not provide medical treatment, diagnosis, or clinical advice.
☐ I understand that all medical decisions and responsibilities belong solely to the treating hospitals and healthcare professionals.
☐ I understand that medical travel involves medical, financial, logistical, and travel-related risks.
☐ I understand that treatment costs, schedules, and arrangements may change.
☐ I understand that no guarantee has been made regarding treatment outcomes, recovery, total cost, visa approval, or travel arrangements.
☐ I authorize Indus International to share my information and medical records with relevant healthcare providers and service partners for treatment review and coordination purposes.
☐ I provide this acknowledgment voluntarily and understand the information contained in this document.
Patient Signature: ___________________________
Patient Representative Signature (if applicable): ___________________________
Date: ___________________________