Demande de devis EasyTrace® cartes d'enregistrement médical

Mrs

First Name *

Last Name *

Telephone *

Company *

Address *

City *

Country *

Email *

Message

Pursuant to Regulation 2016/679 we inform you that the personal data you have just entered will be processed to execute your requests and fulfill the obligations of contract and law in accordance with the provisions of the Privacy Policy.

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Company / Hospital *

Mr o Mrs

Mrs

First Name *

Last Name *

Title *

Email *

Telephone *

Address *

City *

Country *

Medical Device REF *

LOT *

Patient/medical personell involved *

Yes

The involved device is available for pick-up *

Yes

Precise description of the event *

Attachment

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I have read the privacy policy *

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