Date: {{$ActivityAssignDate}}

To,


Sun Pharmaceutical Industries Ltd.

SUN House
Mumbai.

Subject: A retrospective, cross-sectional, observational survey study to analyze the role of Hydroxypropyl methylcellulose (Hypromellose) ophthalmic gel in management of dry eye disease


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 data collection plan

  • All the data shared by me will be retrospective in nature.

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

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

Name:* {{$doctorName}}
Qualifications:
Speciality:
PAN Card No. :*
Postal Address:
PIN Code :
Clinic/Hospital Tel. No. :
Mobile No. :*

*Mandatory to be filled

Yours sincerely,

[Signature & Stamp]
{{$doctorName}}