Patient Medical Facilitation Form

I understand and acknowledge that:

• All diagnosis, treatment decisions, prescriptions, procedures and surgery are determined by the treating doctor and/or Hospital Partner.
• Monk On The Go does not diagnose my medical condition or prescribe treatment.
• Any treatment recommendation received through Monk On The Go originates from the relevant healthcare professional.
• I remain free to accept or decline any proposed treatment.
• The final decision regarding treatment and medical suitability rests with the treating doctor and Hospital Partner.
• Monk On The Go does not guarantee any particular medical outcome, recovery period or treatment result.

I understand that medical outcomes can vary between patients and that complications, changes in treatment, additional procedures and unexpected medical circumstances may occur.

I acknowledge that any treatment estimate, package price or financial quotation provided to me may be based on the medical information available at the time.

I understand that the final cost may vary following:

• Physical examination;
• Additional investigations;
• Change in diagnosis;
• Change in treatment plan;
• Additional procedures;
• Medical complications;
• Longer hospitalisation;
• ICU or specialised care;
• Medicines, implants or consumables; or
• Other circumstances determined by the treating healthcare provider.

I understand that Monk On The Go does not guarantee that an initial hospital estimate will equal the final hospital bill unless the relevant Hospital Partner has expressly confirmed a fixed-price package in writing.

I acknowledge that hospital and medical treatment charges are payable to the Hospital Partner or relevant healthcare provider, unless specifically agreed otherwise in writing.

I will not make any cash or unofficial payment to any employee, representative or agent of Monk On The Go for hospital treatment or medical services.

I confirm that I have disclosed relevant medical information to the best of my knowledge.

I understand that travelling for medical treatment may involve health and travel risks.

Where required, I will obtain appropriate clearance from my treating doctor or healthcare professional regarding my fitness to travel.

I understand that Monk On The Go does not independently certify a Patient as medically fit to travel unless such assessment is expressly provided by a qualified healthcare professional.

I understand that hospitals, doctors, diagnostic centres, airlines, hotels, transportation providers, visa agencies, interpreters and other service providers may be independent third parties.

Monk On The Go may coordinate their services on my behalf but does not control their independent professional decisions, policies or performance.

I acknowledge that:

• Medical treatment is provided by the relevant Hospital Partner and healthcare professionals.
• Airline services are provided by the relevant airline.
• Accommodation is provided by the relevant hotel/accommodation provider.
• Transportation is provided by the relevant transportation provider.
• Visa decisions are made by the relevant government authority.
• Interpretation and translation services may be provided by independent professionals.

I agree that claims arising directly from the professional service, negligence, misconduct or independent decision of such third parties should ordinarily be addressed with the relevant third party, subject to applicable law.

Nothing in this declaration excludes any liability that cannot legally be excluded.

I agree to:

1. Provide accurate, authentic and complete information.
2. Inform Monk On The Go promptly if my medical condition materially changes.
3. Provide updated medical reports when requested.
4. Follow reasonable instructions provided by my treating healthcare team.
5. Comply with hospital rules and applicable laws.
6. Make payments within the agreed timelines.
7. Maintain valid passports, visas and travel documents.
8. Follow applicable immigration and travel requirements.
9. Treat Monk On The Go employees, doctors, hospital personnel, interpreters and Service Providers respectfully.
10. Inform Monk On The Go of any complaint or concern as soon as reasonably possible so that an opportunity may be provided to address it.

I understand that medical treatment and international travel may be affected by circumstances outside the control of Monk On The Go.

These may include:

• Medical emergencies;
• Changes in medical condition;
• Hospital capacity;
• Doctor availability;
• Visa refusal or delay;
• Airline cancellation or delay;
• Government restrictions;
• Natural disasters;
• Epidemics or pandemics;
• Civil unrest;
• Strikes;
• Travel disruption; or
• Other circumstances beyond reasonable control.

I understand that third-party cancellation policies may apply and that amounts already paid to hospitals, hotels, airlines or other Service Providers may not necessarily be refundable.

I agree to indemnify and hold harmless Monk Care International OPC Private Limited, Monk On The Go, its directors, employees and authorised representatives, to the extent permitted by applicable law, against claims, losses, costs or liabilities arising directly from:

1. False, inaccurate, incomplete or misleading information provided by me;
2. Fraudulent or unauthorised documents submitted by me;
3. My failure to disclose relevant medical information;
4. My unauthorised use of the Services;
5. My breach of these Terms or any applicable law;
6. Claims arising from information or documents that I was not authorised to provide;
7. Claims made by an Attendant, family member, sponsor or other person where I did not have the authority to provide their information or make commitments on their behalf; or
8. My conduct or actions that cause loss, damage or third-party claims.

This indemnity does not apply to the extent that a claim, loss or liability is caused by the proven negligence, fraud, wilful misconduct or other liability of Monk On The Go, its employees or authorised representatives, or where such exclusion is prohibited by applicable law.

I acknowledge that I have read and understood the Monk On The Go Privacy Policy.

I provide my consent for Monk On The Go to collect, use, store and disclose my Personal Information and Health Information for the purpose of providing the Services requested by me.

I specifically authorise Monk On The Go to share relevant medical information with:

• Hospitals;
• Doctors;
• Specialists;
• Diagnostic centres;
• Medical professionals;
• Visa authorities/agencies where required;
• Interpreters;
• Accommodation and transportation providers where necessary;
• My authorised Attendant/Caregiver; and
• Other Service Providers reasonably required to provide the Services.

I understand that Health Information is sensitive information and will be handled in accordance with the Monk On The Go Privacy Policy.

I understand that withdrawing consent may affect Monk On The Go's ability to continue providing certain Services.

Privacy Policy: Privacy Policy

I consent to Monk On The Go contacting me through:

for purposes related to my medical treatment, travel, hospital admission, documentation, payments and other Services requested by me.

Marketing or promotional communications, where applicable, will be handled separately in accordance with applicable law and my preferences.