Language:

English

Patient Booking Form

Type of visit

Please select

Patient name:

Аge

Phone

Email

Home Country

Address in Bulgaria

City

Hotel /Street

Room №

Notes

Preferred way to connect with you:

Phone

Whats App

Viber

Other:

DECLARATION OF CONSENTfor personal data processing in accordance with Regulation (ЕС) 2016/679I

I agree my personal data to be processed

Date

06

/

04

/

2025

Time

18

:

40

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