Q.B.F 

Announcement for Muscular Dystrophy Patients


Nectar “T” is of a great importance Natural Nutrition that helps to delay the progress of the disease , succeed better stability & strength and avoid or delay serious complications that are related with Muscular Dystrophy ( i.e Heart failure, Respiratory failure, e.t.c )
TERMS OF SUBSCRIPTION
 
Completion of Medical Records
 
These personal details will be at the disposal of MD doctors who may be interested to observe your situation in relation with the Nectar "T" daily nutrition .
Please read this brochure carefully
If you don't understand any of the symptoms, put an X in the blank space
 
Name:
SurName:
Occupation:
Sex: Male     Female
Country/State:
Address:
Birth Date:
E-mail:
Mobile Number:
Fax Number:
Disease:
Case of Disease:
Year of The First Symptoms of the Disease:
CPK Test Results
(Please write your CPK Results/Levels/Date):
Allergy you may have:
Notes (Please write your personal comments):
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