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Form of Authority

Full Name

Authorise Independent Medical Negligence Resolution(IMNR) to act on my behalf to pursue resolution of my case.

I understand that the IMNR team includes medical experts, mediators and solicitors and that they will consult with me to agree how I wish to pursue my concern.

I have been told and I accept that the Intellectual Property Rights of any report they obtain will remain with IMNR.

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