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Application for dolphin therapy in Almaty - NEMO
Child’s information:
The child’s full name *
Date of birth *
Child's Height (sm)
Weight of child (kg)
Main/concomitant diagnosis *
Epileptic seizures, convulsive readiness
Yes
No
Cancer
Yes
No
Contact information:
Parents’ full names *
Contact phone *
Email: *
Your address
Convenient dates: from
till
Requested services: (tick off where appropriate)
Dolphin therapy sessions
Desired number of sessions:
Tell us how you learned about us:
Additional information
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