Confirmação de dados

Nome:
{name-1}

Email:
{email-1}

Telefone:
{phone-1}

Seguros e outros regimes:
{select-4}

Especialidade:
{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}