Cerere de audienta

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Cerere de audienta

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Numele si Prenumele dvs.

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Numele si Prenumele dvs.

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Insigna + Numele si Prenumele medicului reclamat

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Insigna + Numele si Prenumele medicului reclamat

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Numarul dvs. de telefon

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Numarul dvs. de telefon

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Un email de contact + Numele de pe Discord

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Un email de contact + Numele de pe Discord

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Data Incidentului

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Data Incidentului

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Explicati pe scurt ce s-a intmplat

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Explicati pe scurt ce s-a intmplat

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Atasati un link cu dovada video

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Atasati un link cu dovada video

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Atasati dovada ca poza

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Atasati dovada ca poza

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Numele si Prenumele dvs.

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Insigna + Numele si Prenumele medicului reclamat

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Numarul dvs. de telefon

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Un email de contact + Numele de pe Discord

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Data Incidentului

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Explicati pe scurt ce s-a intmplat

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Atasati un link cu dovada video

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Atasati dovada ca poza

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