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E-subscriptione-subscription

1. Service

Name of service

Physicians

Physicians choice is optional.

Sender

Date

Time

2. Patient data

Name, surname *

Phone *

E-mail *

Age *

Adult

Kid (under 18 y.o.)

3. notes

Additional comments

Saņemt jaunumus no Rīgas 1.slimnīcas

Jā

Nē