redesign consent form

  • Status: Closed
  • Præmier: $50
  • Modtagne indlæg: 10
  • Vinder: pipra99

Konkurrence Instruktioner

please redesign the attached consent form with the following fields:
Patient Information:
First Name
Last Name
Gender
Date of Birth
Phone Number
Mailing Address (Street, City, State, Zip)
Address Matches Insurance? (Yes, No)
Ethnicity
Medicare Member ID #

Family Cancer History: (***note to designer:there needs to be two rows of these same fields***)
Relationship to Patient
Side of Family (Paternal/Maternal/Sibling/Child)
Cancer Site or Polyp Site
Age When Diagnosed

Personal Cancer History:
Cancer Site or Polyp Site
Age When Diagnosed

The form also needs to include the legal text (in the attached document) above the signature line in addition to the signature and date line.

Also, please include our logo (attached) and places for phone, email and website

The form will be filled out by hand by people who are over the age of 50, so please make the text as large as possible as well as plenty of room between lines for writing

Final file must be 8.5x11 inches submitted in a .psd with all editable layers in 300+dpi, please include font files

Anbefalede Evner

Arbejdsgiverfeedback

“professional design, good to make changes, good communication, timely delivery. I would definitely work with this freelancer again!”

Profilbillede aisza, United States.

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    Working...

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    Sir, My entry #4 If any changes required please let me know. Thank you very much.

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    please #sealed

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