PROCOLAGEN I INTACT N-TERMINAL

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Email*

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—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Invoice date*

Patient's official ID* If the patient is a minor, please attach a parent or legal guardian's ID. (PDF, JPG)

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—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Invoice date*

Patient's official ID* If the patient is a minor, please attach a parent or legal guardian's ID. (PDF, JPG)

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—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

Date the study was performed*

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—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

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—Por favor, elige una opción—Observatorio CampusSanta Fe Campus

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Note: Invoices are not issued to insurance companies. Please attach your Tax Status Certificate (Constancia de Situación Fiscal).