Informed consent form of case reports considered to be published in Pamukkale Medical Journal;

Described patient in this paper;
Name-Surname……………………………………………………………………..
Title……………………………………………………………..
Corresponding Author……………………………………..….

I (Name - Surname) ………………………………………………………………………………….


Me and my relation (Name - Surname)
…………………………………………………………………………………


approve publishing of information about me in this scientific journal.
I Informed and approved about this information;
1. This information can be published without name-surname
2. This information can be published in digital form of journal
3. Before publishing I can disclaim my consent or permission, but after publishing I can not.

Signature
Date


Informing Healthcare Professional
Name-Surname…………………………………………………………………….
Signature……………………………………………………………………………
Date……………………………………………………………………………