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            Chronic Pain: First Contact

            "(Required)" indica i campi obbligatori

            Passo 1 di 3 – Contact Information

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            How Would You Like to Be Contacted?(Required)
            We will reach out to you using your preferred method of communication. Please indicate at least one way we can get in touch with you.
            We request your email address so we can send you the necessary forms to complete or contact you to schedule a call, depending on the method you select later in this form. Your email will be used strictly for internal purposes and will never be shared with third parties.
            How Would You Be Willing to Participate?(Required)
            Which of the Selected Methods Do You Prefer?(Required)
            You are not required to do this, but if you’d like to write a few lines about your experience, it would help us better plan the meeting.
            Content Usage Preferences(Required)
            Privacy Agreement(Required)
            The data and information you choose to share will be handled with the utmost care and in full compliance with current personal data protection regulations, as outlined in the General Data Protection Regulation (GDPR). The information you provide will be used exclusively for the purposes of this project and will never be shared with third parties without your explicit consent.

            We are committed to ensuring that everything you share is managed securely and confidentially. If you wish, you may choose to keep your contribution completely anonymous. Additionally, you have the right to access, modify, or request the deletion of your data at any time.

            Your contribution will be used to improve understanding of pain and to raise awareness among professionals and institutions, always respecting the preferences you specify in the form. For any questions or clarifications, feel free to contact us at any time.

            THANK YOU!

            Thank you for taking the time to complete this form. We will get in touch with you as soon as possible. Your contribution is invaluable!
            INNOVAMENTEM A.P.S.

            Via Marco Gatti, 58
            74024 - Manduria (TA)
            CF: 90285270733

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