ADCARE Application form



    Center Information


    Center Address





    Center Contact Data




    Department Information



    Department Head


    Department Deputy



    Application

    Dear Doctor Manuel Pereira,

    I wish to join the Atopic Dermatitis Centres of Reference and Excellence (ADCARE) network and hereby apply for our center to become an ADCARE.


    Please fill in the Power Point document “Center Presentation for Audit_PP template“, save it as a pdf file and upload it here. This presentation is mandatory for the application process and basis for the audit.

    Download the presentation template here

    Upload Center Presentation document: Accepted file types: pdf, Max. file size: 25 MB.

    Please note: Some of the information listed above (including the center’s name and address, contact information for patients, website and logo) may be published on the website of Global Allergy And Asthma Excellence Network. You can find examples of our centers' profiles on the ADCARE page: https://global-allergy.network/adcare/#find-adcare or on https://global-allergy.network/cores/#aa29203c

    My center is already a member of the following Global Allergy and Asthma Excellence networks (required):



    Verify Information

    Please review and verify your information before submitting your application. If you need to change your submitted information, click "Previous" at the bottom of this page to go back.


    Center Information

    Center Name:

    Center Address:

    Center Contact Data:

    Department Data:


    Application

    Please explain why you want to become an Atopic Dermatitis Center of Reference and Excellence:

    Consent: I have read the "32 ADCARE requirements and deliverables" and confirm that our center fulfils the requirements and deliverables.

    I have uploaded the document “Center Presentation for Audit_PP template“, which is mandatory for the application process and basis for the audit: Yes

    My center is already a member of the following Global Allergy and Asthma Excellence networks:


    Signature


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