Dokar online consultations Eng
Please fill out the form to develop a personal low back rehabilitation program
Name *
Date *
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DD
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City, Country *
e-mail *
How to contact you? *
Number for connection *
Your birthday *
MM
/
DD
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YYYY
Your age *
Height *
Wight *
Your officially confirmed diagnosis of lower back disease (if you know)
Stage of the disease *
How long have you had low back problems? *
Indicate the manifestation of the disease *
Required
Most pronounced symptom *
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