Form di Registrazione Centro di Ecocardiografia Fetale.
Registration Form for Fetal Echocardiography Center.

Grazie per averci visitato.
SE NON SEI ANCORA REGISTRATO ..
PUOI FARLO ORA..!!
E' nostro piacere inserirvi in questo sito Web fra i Centri di Ecocardiografia Fetale di Secondo Livello.
Inviateci i dati qui richiesti.
Thank you for your visit.
IF YOU ARE NOT REGISTERED YET..
YOU CAN DO IT NOW ..!!
We have a pleasure to insert your address into Second Level Fetal Echocardiography Center in this web site.
Please send the form below.

Department :
Institution :
Internet url:
Address :
City :
Zip :
Country :
Phone :
Fax :
OBLIGATORY FIELDS :
Responsible :
E-mail :
If you like to point the Center as a "Qualified Center"
Number exam./year : C.H.D./exam...... :
True Positive.... : True Negative.... :
False Positive... : False Negative... :

desidero essere contattato / please contact me

Message / Messaggio (access to examination, booking etc. / accesso alle prestazioni, prenotazioni etc.) :

Department :
Institution :
Internet url:
Address :
City :
Zip :
Country :
Phone :
Fax :
OBLIGATORY FIELDS :
Responsible :
E-mail :
If you like to point the Center as a "Qualified Center"
Number exam./year :	C.H.D./exam...... :
True Positive.... :	True Negative.... :
False Positive... :	False Negative... :

desidero essere contattato / please contact me