redesign consent form

Status: Closed
Prêmio: $50
Inscrições Recebidas: 10
Vencedor: pipra99

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Síntese do concurso

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

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Feedback do Empregador

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

aisza, United States.

Principais inscrições deste concurso

pipra99 Bangladesh

1
Bikashbiswaswub Bangladesh

0
Bikashbiswaswub Bangladesh

0
shazal97 Bangladesh

0
veasnabig Cambodia

0
alimohamedomar Egypt

0
TrexDigital South Africa

0
arifmahmud099 Bangladesh

0
alimohamedomar Egypt

0

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Painel de Comentários

vw8300158vw
- 5 anos atrás
Working...
- 5 anos atrás
arifmahmud099
- 5 anos atrás
Sir, My entry #4 If any changes required please let me know. Thank you very much.
- 5 anos atrás
Bikashbiswaswub
- 5 anos atrás
please #sealed
- 5 anos atrás
Bikashbiswaswub
- 5 anos atrás
Ma'am I am working.....
Please wait for my entry.
Thank you.
- 5 anos atrás