Sunnyside Gynecology
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VISITAS DE SEGUIMIENTO: IUI / IVF
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Nombre
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Fecha de nacimiento
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Número de teléfono
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Dirección de correo electrónico
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¿Es usted paciente del Dr. Brandeis o nos ha remitido para seguimiento externo mediante otro programa? En caso afirmativo, ¿qué programa y persona de contacto?
Fecha solicitada:
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MM slash DD slash YYYY
Tiempo solicitada
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2pm to 2:30pm
2:30pm to 3:00pm
3:00pm to 3:30pm
3:30pm to 4:00pm
4:00pm to 4:30pm
4:30pm to 5:00pm
5:00pm to 5:30pm
5:30pm to 6:00pm
6:00pm to 6:30pm
6:30pm to 7:00pm
7:00pm to 7:30pm
7:30pm to 8:00pm
8:00pm to 8:30pm
8:30pm to 9:00pm
9:00pm to 9:30pm
9:30pm to 10:00pm
Por favor explique si la visita es para ecografía, análisis de sangre, inyección, consulta o inseminación intrauterina.
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