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nouveau praticien
!Nous ne prenons pas de salarié·e!
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Nom
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Prénom
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Numéro de GSM
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E-mail
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Quelle profession souhaitez-vous exercer dans le centre?
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A partir de quelle date?
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Quelle(s) plage(s) horaire (du lundi au samedi, de 8h à 13h, de 13h30 à 18h30 et/ou de 19h à 22h)
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Quels sont vos besoins pour le cabinet (soyez le·la plus exhausti·f·ve possible)
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