Hatzoloh PCR

Acknowledgment of refusal

I hereby acknowledge that I was advised by the Emergency Medical Responders from Hatzoloh Toronto to receive treatment and/or to contact 9-1-1 and request emergency medical transport to an appropriate emergency facility, and that I refused such treatment and/or transportation and understand the consequences of that refusal. I release such persons and facilities from any obligation to provide any service or advice, and from any liability for respecting my wishes, or for any other action or omission with respect to this matter.