All fields of asterisk mark (*) are mandatory.
*Full Name
*GenderMaleFemaleOther
*DOB
*Qualification
*Name of Hospital/ Clinic/Organization
*Address
Affiliations
*Designation
*Mobile No.
Telephone No.
Fax No.
*Email for future communications
*Please enclose a copy of your current CV emphasizing experience in Research (Upload Word or PDF format file, not more than 5mb.)
Key Publications
*What is the most suitable time for our co-ordinators to connect to you over phone taking into consideration your OPD and clinic timings.
Have you participated in any research in the past recent years? YesNo
If yes, please mention the area of interest ?
Asthma0102030405060708090100120130140150160170180190200More than 200
COPD0102030405060708090100120130140150160170180190200More than 200
Other 1
Other 2
Forced Oscillometer (FOT)YesNO
If yes, please specify the company/ provider name of the device
Impulse Oscillometer (IOS) (FOT)YesNO
SpirometerYesNO
Model
Calibration check frequency
Peak Flow MeterYesNO
DLCOYesNo
Body PlethysmographYesNO
Skin Prick TestYesNo
Do you have access to Institutional Ethics Committee (IEC)? YesNO
If yes, name of the IEC?
What is the time frame required to submit proposals of academic studies to the IEC at your institute?”
What are the preferred languages in which you will need the Informed Consent Form (ICF) & Patient Information Sheet (PIS)?
