Fill in the questionnaire, please.
The questionnaire serves for a right determination of an appropriate and efficient product combination,
the document is not being filed anywhere and is not to be used for any other purposes. Your enquiry will be processed
by APOTHECIUM Medical Council, then you will receive an e-mail (on the address you state below) with an appropriate answer.
* Please fill all fields marked in red color
By filling in the form on the www.apothecium.eu site, you are giving your personal information according to the law No. 101/2000 Coll., on personal data protection to company APOTHECIUM s.r.o., which operates www.apothecium.eu.
APOTHECIUM s.r.o. handles the personal data of the people that are registered through the website www.apothecium.eu, as well as all data obtained from questioning or surveys, and that for an indefinite period, to the appeal of the consent of each registered person. APOTHECIUM s.r.o. hereby declares that all the information obtained be considered highly confidential and uses it only for their own use within the meaning of Act No. 101/2000 Coll. on the protection of personal data, to improve their services and for marketing purposes of the company APOTHECIUM s.r.o.
The person providing the information notes that its approval may at any time be writtenly revoked. Your personal information will not be disclosed to others without your consent. On the explicit request your personal information from the database of APOTHECIUM will be erased.