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Consent is hereby given to the staff of Shri Adinath Netralay to conduct
any examination of my eyes and my general system, to perform any diagnostic
tests, to administer or prescribe any medication that is applied to the eye or
taken orally or by injection, as deemed fit by the treating clinician, consent is
also given for the use of the information contained in my medical record for the
purpose of research into eye health and factors associated with it.
Your personal details and identity will not be revealed.
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