Patients Form Patient’s name* Age* Gender MaleFemale Type of cancer, tumour & tumour location Is the tumour cutaneous or subcutaneous? Approximate size of tumour, if known Previous treatment details Chemotherapy Drug used Total quantity of drug given Radiation Is there a recurrence? If yes, how many times? Treated with ElectroChemoTherapy earlier YesNo If yes, what was the response? City/Town Country Contact Email Attach scanned/electronic reports
