{"id":12169,"date":"2017-05-26T09:15:39","date_gmt":"2017-05-26T07:15:39","guid":{"rendered":"https:\/\/www.laurusmedical.ro\/?page_id=12169"},"modified":"2018-11-06T22:24:28","modified_gmt":"2018-11-06T20:24:28","slug":"formular-medici","status":"publish","type":"page","link":"https:\/\/www.laurusmedical.ro\/en\/formular-medici\/","title":{"rendered":"Physician\u2019s Form"},"content":{"rendered":"<p><\/p>\n<h4>Dear Physician,<\/h4>\n<p>&nbsp;<\/p>\n<p>In case you need details on the applicability of LaurusMedical Clinic treatments for your own patients and you desire to find out more scientific data that is not included in the patients\u2019 guidelines, you\u2019re in the right place!<\/p>\n<p>We know that each patient is unique through the range of associated diagnoses and that is why we want to provide you with the best individual diagnosis solution. The one who is most familiar with these problems is the family physicians and\/or the specialized attending physician. That is why the individual dialogue with our physicians is of great value to us. By filling out the form below you will be directly linked to one of our physicians who will provide you with all the treatment details, whether it is about the non-surgical hemorrhoid treatment, the laser varicose vein treatment, MBST\u00ae or a gastroenterology investigation.<\/p>\n<p>&nbsp;<\/p>\n<p>Yours truly,<br \/>\nLaurusMedical<\/p>\n<p>&nbsp;<\/p>\n<p>\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f13757-o2\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"13757\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/12169#wpcf7-f13757-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"13757\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f13757-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:13757,&quot;conditions&quot;:[],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;notice_dismissed_rollback-cf7-5.3.2&quot;:true,&quot;notice_dismissed_rollback-cf7-5.8.3&quot;:true,&quot;notice_dismissed_rollback-cf7-5.8.6&quot;:true}}\" \/><input type=\"hidden\" name=\"_wpcf7dtx_version\" value=\"5.0.5\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p>Name (mandatory)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"nume\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"nume\" \/><\/span>\n<\/p>\n<p>Phone no. (mandatory)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"telefon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"telefon\" \/><\/span>\n<\/p>\n<p>Email (mandatory)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span>\n<\/p>\n<p>Please select the LaurusMedical Clinic (mandatory)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"filiala\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"filiala\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Bucharest\">Bucharest<\/option><option value=\"Bacau\">Bacau<\/option><option value=\"Buzau\">Buzau<\/option><option value=\"Braila\">Braila<\/option><option value=\"Craiova\">Craiova<\/option><option value=\"Deva\">Deva<\/option><option value=\"Focsani\">Focsani<\/option><option value=\"Galati\">Galati<\/option><option value=\"Pitesti\">Pitesti<\/option><option value=\"Ploiesti\">Ploiesti<\/option><option value=\"Suceava\">Suceava<\/option><\/select><\/span>\n<\/p>\n<p>Please select the specialty (mandatory)\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"specialitatea\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"specialitatea\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Proctology\">Proctology<\/option><option value=\"Flebology\">Flebology<\/option><option value=\"Gastroenterology\">Gastroenterology<\/option><option value=\"Dermatology\">Dermatology<\/option><option value=\"Urology\">Urology<\/option><option value=\"Internal Medicine\">Internal Medicine<\/option><option value=\"General surgery\">General surgery<\/option><\/select><\/span>\n<\/p>\n<p>Message\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"mesaj\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"mesaj\"><\/textarea><\/span>\n<\/p>\n<p><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"accept-date\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"accept-date\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span> I agree to the electronic processing of my personal data\n<\/p>\n<p>Your personal data is processed (collected, processed, stored) by Medicover SRL, according to the provisions in the EU Regulation 679\/2016 and to the Healthcare Laws in force, for the purpose of providing medical services. You may exercise the rights of access, intervention and opposition according to the provisions in the EU Regulation 679\/2016, by submitting a written, signed and dated request, submitted in person, sent by mail or through electronic communication means. In case you include an e-mail in your request, you may receive the answer to the indicated email address. Pursuant to the enforcement of the Regulation (EU) 2016\/679 on the protection of natural persons with regard to the processing of personal data and on the free movement of such data and repealing Directive 95\/46\/EC (General Data Protection Regulation), we need your confirmation as to whether you desire to have your email stored address in Laurus Medical SRL\u2019s database and receive further emails. For additional information on data protection, please access the company\u2019s website. Moreover, for any other requests, please contact us at office@laurusmedical.ro\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/p>","protected":false},"excerpt":{"rendered":"<p>Dear Physician, &nbsp; In case you need details on the applicability of LaurusMedical Clinic treatments [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-12169","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Physician\u2019s Form &#187; LaurusMedical - Hemorrhoids, Varicose Vein, Gastroenterology, Dermatology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.laurusmedical.ro\/formular-medici\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Physician\u2019s Form &#187; 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