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By providing the information set out in this form, I consent to Gleneagles Hospitals Sdn Bhd (GLENEAGLES) and their representatives and/or agents collecting, using and disclosing my personal data to provide me with medical treatment and other reasonably related purposes. Such purposes are set out in the GLENEAGLES Data Privacy Policy or available on request. I further confirm that all personal data that I have provided are all true, up-to-date and accurate. Should there be any changes to any of my personal data, I shall notify GLENEAGLES immediately.