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Praxis Dr. Nedoschill
Facharzt für Kinder- und Jugendpsychiatrie und Psychotherapie
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FAQ – Frequently asked questions
Application for first appointment
Contact
Application
To be able to offer you a first appointment, we kindly ask you to provide the information in this registration form.
Fields with
*
are mandatory.
Patient's name:
*
First
Last
Date of birth:
*
day
/
month
/
year
Address:
*
Street Address
City
Postal / Zip Code
Nationality:
*
School, grade:
*
Health insurance:
Your relationship to the patient:
*
Your name:
*
First
Last
Reason for referral:
*
Has your child been presented elsewhere for the same reason?
Your Email:
*
Email confirmation:
*
Telephone number to call you back:
*
In which language may we call you back?
*
Recaptcha Word Verification:
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