Date: {{$ActivityAssignDate}}

To,

Mr. Sandeep Sharma

Associate Vice President,
Sun Pharma Laboratories Ltd.
SUN HOUSE CTS No. 201,
B/1, Western Express Highway,
Goregaon (E), Mumbai-400063

Subject: Effectiveness and Tolerability of FDC of 0.15% Brimonidine/ 0.5%Timolol compared to FDC of 0.2% Brimonidine/0.5% Timolol for the Treatment of Primary Open Angle Glaucoma or Ocular Hypertension in a Real World Setting: A Retrospective Analysis

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 the study plan and 10 Data Collection Forms (DCF)

  • Treatment would be prescribed for open-angle glaucoma or ocular hypertension as in my routine practice.

  • The patient’s identity will not be disclosed in the DCF.

  • You will pay me by cheque a fee of Rs ….. per patient, and accordingly, on receiving the completed CRFs, of number of suggested patients, as a compensation for the extra time spent in record keeping. The cheque for fee may be drawn in favor of “………………………………………………………………………………………..”

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

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

Yours sincerely,

[Signature & Stamp]
{{$doctorName}}