Date: {{$ActivityAssignDate}}

Subject: To Understand the diagnosis and management of GERD patients with overlap GI conditions

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.


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

Name:* {{$doctorName}}
Qualifications:
Speciality:*
Postal Address:
PIN Code :
Clinic or hospital telephone No. :
Residence telephone No. :*

Yours sincerely,

[Signature & Stamp]
{{$doctorName}}