LINK4MED

LINK4MED

PATIENT FORM for Erectile Dysfunction

LINK4MED

Please complete this Form by filling all the required data. All the personal data you disclose to Clinic in this Form it is cosidered confidentioal and is protected against misuse under the law. We will only use your personal data for our needs and will not provide them in any form to another person.

The information in the Form is of high importance for us and it will help the physician in designing the best treatment option for you.

You can fill in document on your mobile phone as well.

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