Confirmação de dados

Nome:
{name-1}

Email:
{email-1}

Telefone:
{phone-1}

Seguros e outros regimes:
{select-4}

Consulta:
{select-1}

Médico:
{select-10}{select-3}{select-7}{select-8}{select-9}{select-11}{select-12}{select-13}{select-14}{select-15}{select-16}{select-17}{select-18}{select-19}{select-20}{select-21}{select-22}{select-23}{select-24}{select-25}{select-26}{select-27}{select-28}{select-29}{select-31}{select-30}{select-32}{select-33}{select-34}{select-35}{select-36}