SaveYourHeart - First approach
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Name
*
Mr.
Mrs.
Prefix
First Name
Last
Age
*
Years old
Email
*
example@example.com
Phone Number
*
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City / country code
Phone Number
Procedure Required
*
Do you have any pain? When did it start?
/
Month
/
Day
Year
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From 1 to 10, please indicate how severe your pain is now.
0 = No pain / 10 = Worst pain
Have you had heart treatment in the past?
Briefly describe any symptoms you have.
How did you hear about us?
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Contact Dr. Vera from U.S. and Canada on their direct phone line (+52) 442 605 1358.
Or email him at: veraheartmd@gmail.com
We respect your privacy.
Your information is confidential and won't be shared.
Thank you.
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