CONTACT US (Select the type of contact to be established) Request for information about the network Guariamoli Request to join the network Guariamoli Report of a clinical case Through this form you can point out to Guariamoli a case that meets the acceptance requirements *. View the conditions for taking charge Guariamoli deals basically young patients whose situation the following applies: No residence in Italy. Severe disease not treatable at home and certified by an appropriate declaration of no curability at home prepared by the treating physician. Maximum age 18 years of age. Any exceptions to these parameters will be agreed from time to time. There are no gender-related restrictions, nationality, religion, political ideology. We will answer as soon as possible. Name of the reporting person: Email address: Phone address: Pathology summary: Patient's age group: (Select the patient's age group) Unborn (indicate months of pregnancy) Up to 3 months From 4 months to 12 months From 1 year to 3 years From 4 year to 12 years From 13 year to 18 years From 19 year to 25 years Oltre i 25 anni Patient's nationality: Other notes to be reported: (Es. where is the patient, his current medical condition, availability of clinical tests carried out at home, certificate of non-curability) Privacy: Enter the security code shown above: (*) It improves performance and prevents the execution of unauthorized automated scripts. Agreement Logo
