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UPITNIK ZA PACIJENTE erektilne disfunkcije / PATIENT FORM for Erectile Dysfunction

Molim vas da popunite sva navedena polja u Upitniku. Sve lične podatke dajete klinici i Upitnik se kao takav smatra poverljivim dokumentom i zaštićen je protiv zloupotrebe zakonom. Mi ćemo koristiti vaše podatke samo za sopstvene potrebe i nećemo ih davati u bilo kojoj formi drugim osobama.

Informacije u ovom upitniku su nam od izuzetne važnosti i pomoći će lekarima da naprave najbolju moguću opciju lečenja za vas.

Upitnik možete popuniti i na mobilnom telefonu.

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.