FICHA DE DATOS PERSONALES

Ficha de datos básicos de pacientes Parkinson

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    Fundación Parkinson Carabobo

    Parkinson Carabobo es un grupo sin fines de lucro que nace con el fin de dar apoyo a pacientes y familiares en relación a la Enfermedad de Parkinson. Queremos conocer mas de su caso y agregar cierta información en nuestra base de datos. Este formulario le tomará entre 2-4 mins para su llenado. Para ello nos gustaría que nos suministrara los siguientes datos.
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    Must be a valid email address
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