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Examination Form
If you visit us for the first time, please fill the examination form.
Stay safe and healthy.
Best wishes
Zatay Medical Pediatric Neurology Clinic
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Name
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Your answer
Surname
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Your answer
Email
*
Your answer
Phone Number
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Your answer
Complaining
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Autism
Seizure (Febrile Seizure - Non-febrile Seizure)
If there is seizure, during the sleep?
If there is seizure, when awake?
Having motoric, cognitive, or speech delay for his/her age
Cerebral Palsy
High Risk Infants (Preterm Babies)
Tuberous sclerosis
Nörofibromatosis
Others
What is the patients's name?
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Your answer
How old is he/she? Please write it.
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MM
/
DD
/
YYYY
What is the patient's history?
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Your answer
Your doctor's choice
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Please choose one of our doctors. Thank you for your understanding and time.
Prof. Dr. Burak Tatli
Prof. Dr. Burak Tatli (Quick Appointment)
Assoc. Prof. Baris Ekici
Assoc. Prof. Fahri Çelebi
Dr. İbrahim Kamer
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