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Terms
All fields which contain
*
are required.
Client
*
Salutation
Mr.
Mrs.
*
Initials
*
Last Name
*
Date of Birth (yyyy-mm-dd)
*
Address
*
Zipcode
*
City
Pickup Address
*
Delivery
At the client.
Somewhere else:
*
ATTN
*
Address
*
Zipcode
*
City
*
Phone number
*
Email
Date and reason
*
Date Cancellation
*
Reason for cancellation
Client does not wish to use the service
Client is no longer suitable
Client has passed away
Client has moved to another location
Dissatisfaction with the performance of Medido (technical issues)
Submit cancellation