SaveYourHeart - First approach
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Name
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First Name
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Age
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Years old
Email
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Phone Number
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Procedure Required
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Do you have any pain? When did it start?
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Day
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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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Dr. Casal's direct phone line +(52) 415.150.1976 from U.S. and Canada.
Or email him at: drcasal.heart@gmail.com
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Your information is confidential and won't be shared.
Thank you.
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