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I hereby waive and release any and all claims or causes for damages or injuries that I now have or hereafter may acquire against Deborah Heart and Lung Center, Deborah Hospital Foundation, Deborah Specialty Physicians and any of their officers, directors, agents or employees, resulting from or arising out of my participation in health screening offerings, the results of the screening or any services or communications provided in connection with this screening. I have voluntarily requested and accepted the screening and agree that the results of the screening are for informational purposes only and do not constitute the diagnosis of any disease or any other illness or health condition, which diagnosis can only be made by a qualified physician. I also understand that the responsibility for having a medical examination performed by my personal physician to confirm the results of screening, and/or obtain advice or treatment related thereto, is mine alone and not of any of the above mentioned companies. I have been offered information regarding follow-up care with abnormal results.

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