ANNEX III
PERMISSION TO BE MENTIONED IN THE ACKNOWLEDGMENTS

If there is a place for Acknowledgments, this document, duly completed and signed, must accompany your manuscript. Your article cannot be accepted for consideration without it. In the event of any doubt, read the instructions for the submission of articles to the Portuguese Journal of General Practice and Family Medicine (Rev Port Clin Geral 2010;26:325-40). Each person mentioned in the Acknowledgments must complete and sign a copy of this form.

The form should be sent by postal mail to:

Director da Revista Portuguesa de Medicina Geral e Familiar
Av. da Rep├║blica, 97-1┬║
1050-190 Lisboa

Identification
Permission to be mentioned in the acknowledgments

I, [full name] hereby consent to being mentioned in the Acknowledgments of the manuscript entitled

of which I/we am/are the author(s)

I declare that I have contributed to the work reported therein or to the preparation of the manuscript, but do not meet the criteria of author as defiend by the Portuguese Journal of General Practice.

Place: Date: / /

 

Signature: ________________________________________