CRDMS Advocacy Form In PDF

CRDMS Member:
6a. Is there a deadline for your action?:


I, the undersigned, clearly understand that the CRDMS Advocacy Committee (“Committee”) is composed of volunteer physicians who are serving in an advisory capacity and are not holding themselves out as lawyers.  I understand that the Committee recommends that I seek the advice of an attorney regarding these matters and not rely solely on any advice the Committee may provide. I understand that all information collected by the Committee in this matter will be kept confidential and that discussion of my identity, if necessary, will only occur in a “closed” session of the Board or general meeting and only after obtaining my written consent.  I understand that the Committee shall not be liable for any loss or damage that may occur as a result of my conferring with them.

I have read the paragraph above and fully understand its contents. I choose to seek the advice of the Committee and, hereby, expressly waive any right or legal action I may have against the Advocate, the Committee and against CRDMS. I sign this Waiver & Consent freely and voluntarily and with an understanding of the nature and the consequences of both.