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← Klinika, laboratorij i ljekarna

Registracija novog pacijenta

Kontakt podaci prije prvog posjeta, uz privolu. Bez medicinskih pitanja: dodajte svoja.

Pitanja

  1. 01Full namekratak odgovor
  2. 02Date of birthdatum
  3. 03Genderjedan izbor
  4. 04Mobile numbertelefon
  5. 05Emergency contact (name and phone)kratak odgovor
  6. 06How did you hear about us?jedan izbor
  7. 07I agree that the clinic may keep these details to arrange my care and contact me about it.privola