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ISCELIVANJE
Special contents:
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Password:  

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Dear clients (users therapeutic services), we ask you to fill in this inquiry but only after ending your therapy and to send us by e-mail or fax.

All your information is confidential and your anonymity is guarantee.

Here you can take the inquiry in .doc(Word) .or in pdf (Acrobat) format.

Anketni_list.doc

Anketni_list.pdf

Or you can write it now and send us:

INQUIRY:

For users who take therapeutic services

Data from inquiry will be use only to make therapeutic services better and for improvement the users due.

Data of yours therapist:
*First and last name:
Cooperatio:
Adress:
City:
Phone:
*Therapy:

* Compulsory items
Yours data:
*First and last name:
Passport data:
Adress:
City:
Phone:
Mob. phone:
*E-mail:
Country:
Therapist was recommended me by:
 
On the therapy I was:
 
One therapy continue:
and it’s cost
*On therapy I come because of illness/problems:
 

*Compulsory items
And because:
a) official medicine can’t help me
b) I avouch only natural/energetic/mental helping aspects
     c) 
At first the diagnosis assigned me:
a) the doctor
b) therapist
     c) 
d) I don’t have diagnosis still
*If the diagnosis assigned the therapist he/she did it at this way:
 

*Compulsory items
Is your therapist also a qualified doctor?
a) YES, he is.
b) NO, he is not.
By the results of therapy I am satisfied:
 
I am satisfied by:
 
I am not satisfied:
 

 

DVA KALJA

“Perfekt Derma”

Novi Sad
Gajeva 17 / 18

021/ 451-397
064/3200-502

Zakazivanje tretmana unapred

Tretmane radi:
-Dragan D. Vojinović

Obuka za terapeute se vrši dva puta nedeljno za 12 polaznika.