I hereby consent to undergo consultation, assessment, treatment, counselling, therapy at CINQ.IN & its affiliated clinics / Health centers.
I understand that professionals and staff at CINQ.IN provide services. care and act in good faith of the client. In event of adverse outcomes due to relatives or clients acting against advice or their negligence or any other scenarios, the client or relatives would not hold professionals, counsellors, management or staff responsible or liable for any consequences arising form above.
I hereby give my consent to use any information provided by me for research or educational purpose after removal of Name, contact no, and other directly identifying information.
I declare the information provided by me and my relatives / friends is reliable and correct.
I give my consent to receive transactional or promotional SMS, Emails, Calls from CINQ.IN
I understand CINQ.IN does not provide emergency services, in case of emergency I should approach the nearest hospital or contact emergency response support system (112 in India)
I understand in cases of harm to self or other, abuse of underage client, serious crimes, threats or sexual assult - I am advices to report the incident to proper authorities. If I fail to do so, CINQ.IN reserves the right to report such insidences at the management's own discretion.
I understand that therapy / Counselling sessions are charged by time spent with the professional, therefor any time spent beyond the initial consultation time of 45 mins will be charged by 15 min intervals.
I understand the above terms or they were explained to me in language known to me.
