Health Chat Request

Please fill the form to request your first Health Chat

First Name *
Last Name *
Institution
Contact email *
Country *
City or town
Disclaimer Health Chats are information sessions. They are not to be used for diagnosis or treatment of a health problem or a disease. Health Chats do not create doctor-patient relationship between the parties. The participants are personally responsible for ensuring their own safety and wave any claims related to injury or harm resulted from the use or misuse of the information presented during Health Chats.
Informed consent *
In order to send a request for Health Chat you must have read and understood the disclaimer.I 've read and understood the disclaimer and want to go ahead with Health Chats