Evelyn Enterprises | Your Logistics Partner

Dear Doctor,

Evelyn Enterprises Pvt Ltd. has partnered with Cipla for patient support program which is termed as Nebulization Access Program (NAP). Prerequisite of this program is to provide patient data to Evelyn Enterprises Pvt Ltd post distribution of Nebulizer to patient within a month of its receipt. This data will be stored safely with us and will not be disclosed or used for any commercial or non-commercial purpose.

Best Regards,
Evelyn Enterprises Pvt Ltd

DECLARATION LETTER

To Evelyn Enterprises Pvt Ltd.

I/we undersigned, wilfully provide my/our consent for handover of patient data for Nebulizers distributed to patients under patient support program i.e. Nebulization Access Program to Evelyn Enterprises Pvt Ltd. This data will enable Evelyn Enterprises Pvt Ltd. to seamlessly handle the mentioned program.

Best Regards,

*Doctor Name:

*Doctor's Mobile Number:

I agree

Sr. No	Patient Name	Gender	Contact No	Action