Formularz Demograficzny

Female Partner Data - Dane Partnerki

Date of Birth * - Data urodzenia *

Male Partner Data - Dane Partnera (if exists - jeśli istnieje)

Date of Birth

Contact Data

By whom were you referred to the Assisting Nature Unit?
Kto polecił Ci Klinikę Assisting Nature
Former Patient'sWebsiteYours gynaecologistFriend
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Without further authorization, my personal data and result of the treatments can be used in scientific research, while protecting the personal identification from the data. Enclosed information is strictly confidential. Assisting Nature follows certain patients’ information policies in order to protect sensitive information, as it is strictly required by Greek and European Union applicable Laws and directives.