Topic of a manuscript or photos: (for Author use only)
Author’s full name who provides a material: (for Author use only)
Address and e-mail: (for Author use only)
(for Patient or her/his official representative use only):
I give my consent to publish materials with my participation in the Journal of Health Development.
I have seen all figures and read material to be published.
I understand that:
- my name will not be published although I understand that full anonymity cannot be guaranteed;
- material will be published in one of the issues of the Journal;
- material will be available on the Journal’s website and can be read by doctors and other members of the public;
- material can also be used in public bases on medical researches;
- material will not be used for commercial or packaging design;
- material will not be used out of the context.
Patient’s full name:
Date of completion:
(If you are patient’s official representative please indicate ancestral relationship)