Release of Liability for health care facility in California by compliancedoctor

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									                               GENERAL RELEASE
         For good and valuable consideration, the receipt and sufficiency of which are
hereby acknowledged, including the receipt of $______, the undersigned ____________
on behalf of himself and each of his respective agents, servants, successors and assigns
(“Patient”), hereby fully, finally, and forever releases and discharges (name of health care
facility) , and each of their directors, officers, managers, shareholders, employees,
independent contractors, agents, successors and assigns (individually and collectively,
“(name of health care facility)”), from any and all past, present and future claims, suits,
judgments, damages, debts, sums, amounts owed, obligations and controversies,
liabilities, losses, costs, expenses, liens, charges, fees (including attorneys' fees),
damages, lawsuits, actions and causes of action of every kind and nature, whether in law
or equity, and whether known or unknown, foreseen or unforeseen, patent or latent, or
absolute or contingent, which Patient has had, now has or could have against (name of
health care facility) by reason of the provision of medical services by (name of health
care facility) and/or any fact or circumstance arising out of any alleged act or omission
while Patient was located or as a result directly or indirectly of any treatment while at
(name of health care facility)’s facility located at (address of health care facility)

       Patie
								
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