Authority & Consent Form

The bearer(s) are authorized staff of Mashaal Wellness Center, Banigala, Islamabad. They are accompanying a psychiatric/addiction patient for treatment as requested by the family. Your assistance is requested as the patient may pose a security concern.

Patient Name: *

Father Name: *

Address:

Contact No.:

Emergency Contact: *

Guardian Consent

I, as guardian of the patient, hereby give consent for his/her treatment at Mashaal Wellness Center, Banigala, Islamabad. I have understood and accepted the rules and procedures of treatment of the Clinic.

Guardian Name: *

S/O (Father Name): *

CNIC: *

Relation: *

Address:

Contact No.:

Email Address:

Date: *

I hereby confirm that we have read and fully understood the clause regarding emergency and involuntary intervention, and expressly authorize and consent to the implementation of such measures for the patient as part of their treatment and care.

Terms and Conditions

In this institution, we deal with various types of mental health and addiction issues. We also treat behavioral and stress-related problems by using psychotherapy and other evidence-based methods.
The initial time period for these treatments is a minimum of one hundred Twenty (120) days. However, this period may be extended based on the assessment of Doctor/Psychologist.
The patient and/or their family will be responsible for all other expenses, including any additional medical issues that may arise during their stay.
The management reserves the right to discharge any patient in case of non-cooperation from the patient and/or their family.
All phone calls, visits, and family meetings will be scheduled only by Mashaal Wellness Center's professionals.
Any interference during treatment by the patient's family members will not be acceptable. In such cases, the patient and/or their family will be responsible for any negative consequences.
During the patient's stay, Mashaal Wellness Center will not be responsible for any incidents of self-inflicted harm, medical emergencies, or other health issues that may arise.
In situations where the patient exhibits behavior that poses a risk to themselves or others or is unable or unwilling to cooperate with necessary treatment, the patient's family/legal guardian hereby authorizes Mashaal Wellness Center to take appropriate clinical measures in the best interest of safety and care. This may include, but is not limited to, supervised or assisted administration of medication, physical restraint (only when absolutely necessary and as a last resort), or other emergency interventions in accordance with established clinical and ethical guidelines.
Such interventions will be carried out by qualified professionals with the least restrictive approach and for the minimum duration required. The family/legal guardian acknowledges that these measures may be necessary to stabilize the patient and prevent harm and agrees not to hold Mashaal Wellness Center or its staff liable for actions taken in good faith under such circumstances.
The institute's recommendations and treatment plans must be taken seriously. It is the responsibility of the patient and their family to comply with the treatment plan and all prescribed medications. The staff at Mashaal Wellness Center are responsible for providing safe, ethical, and effective treatment, designed in the best interest of the patients. However, if a patient does not show improvement, neither the patient nor their family will hold Mashaal Wellness Center responsible.
The patient and/or their family will be responsible for all treatment costs and must ensure timely payment of all fees and remaining dues at the time of discharge.
Any form of unnecessary interference, emotional pressure, or disagreement with Clinic treatment plan from respectable family members will not be accepted as it may negatively affect the patient's recovery process. All family members are requested to follow and accept in true letter and spirit the stipulated treatment plan.
While Mashaal Wellness Center is committed to providing the highest standard of care and making every reasonable effort toward the patient's recovery, no guarantee or assurance of complete recovery or specific outcomes can be provided. The patient and their family acknowledge that mental health treatment involves inherent uncertainties and risks, and despite best efforts, the possibility of limited or no improvement, relapse, or unforeseen complications cannot be entirely ruled out.

I have read, understood, and agree to all the terms and conditions stated above. *

Final Acknowledgment

I hereby confirm that I have read, understood, and agreed to all the terms and conditions stated above and sign below in full acknowledgment and satisfaction.

Name: *

Son/Daughter of: *

Date: *