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Enrolment form for CanHelp Project

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Site Name:*

Site Address:*

Phone:*

Email:*

In order enable us to assess the number of iPads required at your Center, please describe briefly about number of clinics & Oncologists available in the center and Patients being treated annually*

Your name:*

Designation & general responsibility:*

Contact Phone:*

Email Contact:*

I am fully authorized by my Cancer centre management to have enrolment in CanHelp Project.*

I acknowledge that CanHelp-iPads provided under CanHelp project are for in-clinic use only and same will not be taken outside from cancer centre.*

I acknowledge that in case one or all CanHelp-iPads will be no more in use in the cancer centre, then the out of use iPad(s) will be returned to Canris Technologies immediately.*

I acknowledge that an internet connection will be provided to CanHelp-iPads for time to time Apps Updates and remote management.*

I acknowledge that CanHelp iPads & accessories will be used very carefully to avoid any damage to the device and property.*