CLINICAL CASES

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NAME AND SURNAME

PROFFESIONAL LICENCE NUMBER

E-MAIL ADDRESS

PHONE NUMBER

PATIENT AGE

PATIENT GENDER

Woman Man

TOOTH NUMBER / TEETH

ARKONA products used during the procedure

BRIEF DESCRIPTION OF A CLINICAL CASE

SHORT DESCRIPTION OF THE WORK

PHOTO BEFORE TREATMENT

PHOTO DURING TREATMENT

PHOTO AFTER TREATMENT

EFFECT SUMMARY

GDPR 1

I consent to the use and publication by ARKONA Laboratorium Pharmacologii Stomatologicznej Grzegorz Kalbarczyk (hereinafter referred to as ARKONA) of my photos/materials for marketing, educational and internal documentation purposes of ARKONA. The consent covers the photos and descriptions that constitute the content of this form. The consent is given for an indefinite period of time and free of charge. I declare that the photographs were taken by me personally, that I have all the rights to them and that the persons visible in the photos have consented to the publication of their image.

GDPR 2

I have read the information clause, the content of which is available at www.arkonadent.com, regarding the processing of my personal data by ARKONA for the purposes of implementing the ARKONA in practice campaign – clinical cases, the content of which is available at www.arkonadent.com

NEWS AND MEDICAL KNOWLEDGE

Send us your clinical case.