Referrals

In this section, you can send me the details of your patient’s medical conditions.
I will be happy to cooperate with you!
For a complete consultation please fill in as many fields as possible to have complete clinical information.

    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    YesNo
    I accept the conditions of use of the site and the information on the processing of personal data. *