Patient registry PDF Print E-mail

 

 

JOIN THE GFB PATIENT REGISTRY



To register in the GFB patient registry, send an email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it with the following data:

 

  • NAME SURNAME
  • AGE
  • NAME OF THE DISEASE
  • YOU HAVE A GENETIC (DNA) CONFIRMATION OF THE DISEASE YES / NO
  • ADDRESS
  • TELEPHONE NUMBER
  • E-MAIL
  • MALE FEMALE
  • OTHER REMARKS
 
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