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To be used for Labiofam - Dr Niudis Cruz - e-mail: labiofam@ceniai.inf.cu - Send to Labiofam Laboratories in Cuba to Dr Niudis CRUZ. - Fill out the information and submit Name: - Last name:....

Questionnaire Template


To be sent to Labiofam Laboratory

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to Dr Niudis Cruz /CUBA


e-mail adress: labiofam@ceniai.inf.cu

With medical exams, diagnostic and clinic patient history

Fill out the information and submit

  • First name:...

  • Last name:....

  • Sex:...

  • Age:...

  • Weight:...

  • Height:...

  • Pathology:...

  • Current location in the body:...

  • Treatments:...

  • Current Symptoms:...

  • Country:...

  • City:...

  • Phone:...

  • e-mail adress:...


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