I hereby agree to the following, and provide my consent to the disclosure and use of my personal information, as set out below:

1. I am a linked-person to the Member-patient

2. My personal details include my name, birthdate, email address, phone number, ID/passport number, photo, as well as my medical history, surgical history, allergies, current medication, and current doctors.

3. I have specified the Patient-member in the Member Onboarding Form.

4. My residential address has been specified in the Member Onboarding Form.

5. I have been informed by the Patient-member of the nature of the membership.

6. I agree to be linked to the profile of the Patient-member on Infinity Medical Concierge.

7. I understand that I may de-link myself from the profile and the Platform at any time.

8. I understand and agree that being linked means that I am associated with the membership of the Patient-member.

9. I understand and agree that my personal- and health information uploaded, logged and/or used on the  Infinity Medical Concierge platform remains confidential, and not accessible by the Patient-member.

10. I also understand that I may provide consent to the uploading of existing health records by myself/Infinity Medical Concierge and/or my healthcare professional unto the Platform.

11. I understand that I am able to provide permissions to any healthcare professional and/or the Patient-member or any other person linked to the patient member, to access my health- and personal information stored on the Platform, even if that information was generated by another healthcare professional. I understand that any access and permissions provided can be withdrawn, in writing, at any stage.

12. I have read, understood and agree to the Privacy Policy of Infinity Medical Concierge.