This Affidavit of Health Template from Template.net is designed to record declarations regarding an individual's health status, crucial for various contexts such as travel, employment, or healthcare facilities. With editable fields and customizable sections, our AI editor tool enables users to personalize the affidavit according to specific requirements effortlessly. Promote well-being with confidence.
I, [Your Name], of legal age, residing at [Your Address], hereby depose and state as follows:
Statement of Facts
I am over the age of 18 and am competent to make this affidavit.
I am fully aware of the legal consequences of making this statement under oath, and I solemnly affirm that the following statements are true and correct to the best of my knowledge and belief.
I am filing this affidavit in relation to the legal case of [Case Name], currently pending before the [Court Name] in [Your State], wherein I am the victim.
On [Date of Incident], I was involved in [Incident] at [Location].
As a result of the incident, I sustained injuries to my [Injured Part], which have impacted my health and well-being.
The injuries I sustained have caused me significant physical pain, suffering, and emotional distress.
I have attached medical records and reports documenting the nature and extent of my injuries, as well as any treatments received.
I hereby authorize the use of these medical records and reports as evidence in the legal proceedings mentioned above.
I affirm that my health status and the injuries sustained are accurately represented in the attached medical documentation.
I make this affidavit in support of my claims in the aforementioned legal case and for no improper purpose.
Sworn Oath
Further, I declare under penalty of perjury under the laws of the State of [Your State] that the foregoing is true and correct.
Executed on this [Date] day of [Month], [Year].
Sworn to and subscribed before me this [Date] day of [Month], [Year].
