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By agreeing to consent to participate in the Healthy Heart counselling program, I hereby agree to receive advice from the appointed counsellor on lifestyle modifications that I could possibly make for better management of my condition through phone calls, SMS/WhatsApp messages. As part of this service I understand, Saarathi and/ or its appointed representatives may capture some basic personal & health related information for their records so as to enable me to participate in the initiative. I understand that my consent & enrolment in this activity is completely voluntary and that I have the right to decline this service if I wish to. I also fully understand that this counselling advice has no impact or influence on my consultation and treatment which I shall continue to receive from my doctor whether I enrol for this initiative or not. I have read & fully understood the content of this form before signing it & I have had opportunity to ask question about use of my personal information.