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Nachname **/

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Vorname **/

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Fachtitel - mehrere Fachtitel mit Komma trennen **

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Jahrgang im Format 1962 (4-stellig)

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Nationalität (Schweiz, Deutschland, etc.)

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Berufssprachen (bitte nach Komma trennen) **

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Name der Institution, Praxis, Firma in welcher Sie tätig sind

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Strasse

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Postleitzahl

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Ortschaft

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Kanton
Telefon P

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Mobiltelefon

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E-Mailadresse
Praxis Name **

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Angebot Praxis **

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Delegiertes Arbeiten **

Strasse Praxis **

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Postleitzahl Praxis **

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Ortschaft Praxis **

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Kanton (Geschäft) **
Telefon Praxis **

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E-Mail-Adresse Praxis **
Webseite Praxis **

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Krankenkassenabrechnung **

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FPI-Ausbildung

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Ausbildungszweig

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zusätzliche Ausbildung

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Arbeitsschwerpunkte

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Behandlungsschwerpunkte

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Verbände

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Praxisbewilligung

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Kanton (Praxiserlaubnis)
Name nicht auf der öffentlichen Benutzerliste führen
Ja, ich möchte alle Angaben in den markierten Feldern in der öffentlichen Liste „TherapeutIn suchen“ aufführen **