Date: {{$ActivityAssignDate}}

Subject: Cross sectional survey to assess disease perceptive and management practices of chronic constipation in Indian physicians.

In response to your letter dated _________, I agree to participate in the study as outlined by You.


I understand that:


  • You will provide me with a copy of data collection form..

  • This data collection form will have questions about the disease perspective and management practices of chronic constipation in adults

  • No any prospective data will be captured in this study

  • You will provide the assistance of a monitor to verify and to collect the DCF.


My personal details are given below for accuracy of your records.

Name: {{$doctorName}}
Qualifications:
Speciality :
Postal Address:
PIN Code :
Clinic or hospital telephone No. :
Mobile Number :
Email ID:
PAN Card Number:

Yours sincerely,

[Signature]
{{$doctorName}}