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Agreement and Authorization Form

You can download the agreement and authorization form.
Both are in PDF format. You should print and complete them by hand and then send them via fax, email or postal mail.

To send it via fax:
0054 02322 49 5585 Int. 17

To send it via e-mail:
documentos@esclerosis-multiple.com

To send via postal mail.
Alicia Moreau de justo 1780, Piso 3.º. Ofi.: F-B
1107. Capital Federal.


If you cannot read PDF files, you can download Acrobat Reader by clicking here:



Download both forms:
Agreement Form.
Authorization Form.

Explenation:

- Both the agreement and authorization form must be completed prior to the commencement of treatment.
- In the agreement form, point Nº5 must be left blank. This will be completed by us.
Teléfonos:

0054 02322 49 5585
Monday through Friday from 10 pm to 17:30 hours in Argentina. Or leave a message.

From other countries,
0054 11 4361-2974
Monday through Friday from 10 pm to 17:30 hours in Argentina. Or leave a message.

Email:
roderick.tozer@esclerosis-multiple.com


Interview of Dr. Ayrad Omar by Claudio Dominguez.


First interview by Claudio Dominguez of Dr. Ayrad where the doctor tells us by way of introduction what the phytotherapeutic treatment is all about.
see more videos »