Patients Form

Patient’s name*

Age*

Gender

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

If yes, what was the response?

City/Town

Country

Contact

Email

Attach scanned/electronic reports