This app was written to provide source data for databasing resident call information at a major University. Fields included on the form summarize the primary information important to additional action. This data can be e-mailed to affect inclusion in a central database and/or maintained on the user device. E-mail output can include a text summary of the form as well as a CSV(Excel/Numbers compatible) spreadsheet of all or any number of the stored form entries. A copy of the Consent form can be e-mail/AirPrinted for off device storage. Individual patient information can be deleted as needed. The consent form can be signed by the patient and Doctor by finger or stylus.