Section 1

Legal Disclaimer – Terms and Conditions

1. International Surgery Group also known as ISG offers the highest levels of service. Our reputation of high standards is paramount and therefore at all times ISG tries to source high quality healthcare. All hospitals and clinics are inspected and their surgeons and physicians carefully vetted by the Belgian Governmental Department of Health however, ISG cannot warranty or guarantee levels of service provided by hospitals, clinic, doctors or surgeons. If you believe that our partner surgeons, physicians, hospitals or clinics are failing in any way, please contact us immediately so that we can try to rectify it as soon as possible!

2. Unless explicitly stated we do not offer methods of transport and/or accommodation as part of our services,however, upon request we may oblige and in such an event the particulars will be at our discretion. Any costs omitted or corrections to your invoice may be invoiced/credited later. International Surgery Group is not liable for any expenses whatsoever incurred by its clients not agreed in the initial proposition in writing. All advertised/advised/published pricing, terms & conditions, hospitals, treating physicians and / or places of accommodation are subject to change at any time without notice.

3. Prices shown on the website are for guidance purposes only and may bear no relation to prices quoted or invoiced. Quoted prices are held for a period of 10 consecutive days. If the client has not availed of the quoted price after the 10 day quotation period, prices can be amended or changed by ISG or its representatives. 3a. Surgical applications which have been given green light approval from our partner surgeon, must confirm their intention to proceed with surgery on the mutually agreed date in no later than 30 business days from the date of surgical approval. Applicants can only confirm their surgery with the appropriate deposit.

3b. Failure to confirm with a deposit within the specified time frame will result in the application being deleted and the applicant will be required to re-submit a new application should they wish to proceed with surgery. 3c. Second and subsequent applications are subject to our partner surgeons review process and may on medical grounds be refused should any contraindications arise that were not present in the first application.

4. Payments must be in full prior to treatment. Any persons seeking treatment that has not been paid for in full will be refused treatment.

4a. Deposits are required at the time of booking. Surgical Confirmations will only be issued once ISG has received your surgery deposit by either Bank Transfer or Bankers Draft. Bankers Drafts must be received 30 days in advance of any treatment. In compliance with Irish and Eurpoean legislation a 14 day cooling off period applies to all deposit payments beginning on the date that the payment is initiated. During this cooling off period a patient reserves the right to request his or her deposit back and a full refund will be provided. After the 14 day cooling off period deposits are not refundable.

5. Exceptionally and / or due to unforeseen circumstances there may be additional costs incurred for reasons of extra treatment, an additional hospital stay, hotel or accommodation or further medication not included in the initial proposition. Should there be subsequent additional costs, these will be discussed with the patient and a provisional cost indicated. Any such additional costs will be billed at a later date and must be paid within 30 days of invoicing. The Hospital reserves the right to add an administrative service charge of 3% per month for delayed/non-payment.

6. Patients can avail of the ISG Insurance Cover for patients traveling overseas for surgery, however, strict Terms and Conditions govern the sale of this insurance cover.

7. The patient/debtor shall pay any costs, charges and expenses incurred by the process of recovering any debt. ISG, the hospital or the treating surgeon reserves the right to pass any outstanding debts to a third party for collection. If a payment made by cheque is dishonored, the patient/debtor shall be liable for all costs incurred as a result.

8. ISG reserves the right to liaise with credit reference and other agencies with regard to a client’s status and submit information accordingly and in line with relevant legislation. ISG also reserve the right to refuse any client without giving a reason. Certain services may only be available to qualifying persons or person’s in particular geographical areas.

9. ISG reserves the right to transfer any debt in part or whole to a third party. This may include the use of a factoring or other finance company for the assignment of debts to us. All existing liabilities from the client will remain valid.

10. ISG does not warranty or claim that any information presented on our website/websites is correct or accurate. All such information cannot be relied upon in making any medical diagnosis or decisions. Neither International Surgery Group nor its employees directly or indirectly practice medicine, or give medical advice. Information presented on the ISG website or websites, in ISG brochures, booklets, leaflets and sales documents is compiled from a variety of sources and should not be used for medical advice or in place of a professional consultation with a doctor. Never disregard the advice of a physician or other qualified health care provider because of any information presented on ISG website or websites, or in ISG brochures, booklets, or leaflets.

10. International Surgery Group cannot be held liable or responsible for any detrimental treatment or actions of doctors, surgeons or hospitals. International Surgery Group is simply an intermediary providing access to surgery and surgeons in its partner hospitals and clinics.

11. Patients who elect to discharge themselves from the hospital facility against the recommendations of the surgeon or medical team do so at their own risk and will have no legal recourse against the treating surgeon the hospital or International Surgery Group should an emergency or other situation arise.

12. International Surgery Group respects and protects the privacy of its clients. Personal details, including email address and telephone numbers are treated in confidence. These will not be disclosed to any third party, except in connection with the provision of requested services. ISG do not send out unsolicited emails (‘spam’) and email address are not submitted or disclosed to any mailing lists organisations. All personal records received are used for the sole purpose of administering the treatment. International Surgery Group complies fully with European Legislation on privacy protection in relation to the storage and processing of personal data.

13. International Surgery Group facilitates the transfer of information and medical records between the clients (wherever they are in the world), their doctor or specialist, and the local surgeon or physician. Any information that is stored temporarily by International Surgery Group about a client, is held in a secure environment and is not listed or associated with the name of that patient, thus retaining confidentiality. Further this information is not released to anyone without the express permission of warranties or service agreements.

14. International Surgery Group and our partner surgeons constantly strive to deliver excellent patient safety. As a consequence clients attending for surgical treatment are upon hospital discharge, required to rent accommodation in the immediate vicinity of the treating hospital (within a 5 mile radius of the hospital) until their post-operative check with the Nurse has taken place. This requirement is in place to protect the client in the event that the client may need to be re-admitted to the hospital in an emergency situation. Clients who choose to stay beyond the 5 mile radius of the treating hospital do so at their own risk and will have no legal recourse against International Surgery Group, the treating surgeon or the hospital should an emergency or other situation arise.

15. Clients who disregard the reasonable request by International Surgery Group, the treating surgeon and the hospital to choose hotel accommodation within the 5 mile radius of the Hospital may be refused surgery by International Surgery Group or the treating surgeon and in this instance any deposit paid is not refundable.

16. Clients who choose to stay in accommodation outside of the recommended 5 mile radius from the hospital are not covered by the International Surgery Group’s Surgery Insurance Policy nor will International Surgery Group cover the cost of admittance to other hospitals or medical facilities in Belgium.

17. Clients whose BMI (Body Mass Index) exceeds 48 will be required to stay two nights in Hospital as a minimum. Patients who are aged 48 and over will be required to undergo a Pre-Surgery ECG Exam and a Chest X-Ray. The tests should be arranged by the client’s G.P. If the client requires the hospital to carry out these tests additional fees will apply. All tests should be forward to International Surgery Group no later than 7 business days prior to the intended surgery date.

Section 2

Informed Consent

18. The details of the proposed procedure have been explained to me in terms I understand. Alternative

methods and their benefits and disadvantages have been explained to me. I was informed that the international

standard for bariatric surgery (USA-NHI, 1991) is a minimum of BMI 35 (with co-morbidity) or BMI 40 (without co-
morbidity). If my BMI is lower than this international standard, I nevertheless decide to go ahead with surgery

and take full responsibility for the indication for obesity surgery myself.

19. I understand and accept the most likely risks and complications include but are not limited to:

• abscess formation

• allergic reaction to medications, anaesthetic agents, or solutions used

• anaesthetic complications, sore throat, dizziness, blurred vision, shivering, headache

• blood clots

• blood clots that occur in leg veins may travel to the lungs as pulmonary emboli

• blood vessel injury

• bowel obstruction

• cardiac complications such as cardiac arrhythmias (irregular heart beat) or cardiac arrest (heart attack)

• dehiscence (separation of the wound)

• dehydration

• severe bloating of the stomach; ulcers

• failed procedure (surgery is unsuccessful)

• leaks at the gastric stapling line

• gastro-gastric fistula

• haemorrhage form any site but especially

• haemorrhage at the staple lines

• infections, generally at the wound site, but may occur elsewhere

• inflammation

• nerve injury

• injuries to blood vessels (veins, arteries) or abdominal organs during the procedure

• reflux, nausea, vomiting, difficulty swallowing

• organ injury, especially spleen or diaphragm

• stomal stenosis

• various respiratory difficulties

• wound infection

• Incisional hernia

• Internal herniation

• gallstones due to rapid loss of weight in a short period

• intestinal blockage due to adhesions or to internal herniation

• nutritional deficiency

• inadequate weight loss is a risk of all types of weight loss surgery and treatments within the operative area

• osteoporosis

• depression

• death

20. I understand that I will need additional counselling related to dietetics, rehabilitation, and other services as deemed necessary by my physicians.

21. I understand that as a result of my chronic pre-existing medical conditions, I am at great risk for any or all of these complications to occur.

22. I understand and accept the risks of blood transfusion(s) that may be necessary.

23. I understand that tissue cannot heal without scarring and that how one scars is dependent on individual genetic characteristics. The physician will do his/her best to minimize scarring but cannot control its ultimate appearance.

24. I understand that the doctor may, at any time before or during the procedure, end the surgery.

25. I am aware that smoking during the pre-and postoperative periods could increase chances of complications and it needs to be avoided.

26. I have informed the doctor or International Surgery Group of all my known allergies.

27. For female patients only: I confirm I am not pregnant.

28. I have informed the doctor and International Surgery Group of all medications I am currently taking, including prescriptions, over-the-counter remedies, herbal therapies and supplements, aspirin, and any other recreational drug or alcohol use.

29. I have been advised whether I should avoid taking any or all of these medications on the days surrounding the procedure.

30. I am aware and accept that no guarantees about the results of the procedure have been made and that the predicted weight loss is based on population means.

31. I have been informed of what to expect post-operatively, including but not limited to: estimated recovery time, anticipated activity level, and the possibility of additional procedures.

32. I understand that I should not become pregnant until one to one and one-half years after this surgery.

33. I understand that the doctor can appoint associates or assistants to help him during this procedure.

34. I understand that the operation can be attended by visiting surgeons.

35. I understand that I will be required to complete a manual Informed Consent form following my surgical Consultation.

35. This contract shall be subject to the laws of Ireland and construed in all respects as an Irish contract. If any sections or individual terms of this statement are found at any point to be non-enforceable or incorrect, the content or validity of the remainder of this document will not be affected.

18. These policies exclude any disclosure, which we are required by law to make.