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<P><STRONG><FONT color=#0000ff>Detox Center Μεσογείων 429 2ος,
Αγία Παρασκευή, 210 6009008 </FONT></STRONG><A
href="http://www.detoxcenter.gr"><STRONG><FONT
color=#0000ff>www.detoxcenter.gr</FONT></STRONG></A></P>
<p class=MsoNormal><span style="DISPLAY: none; mso-hide: all"
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<tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes"
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<p class=MsoNormal><b><FONT color=#80ff00 size=5>Το
Detoxification Program τώρα και στην
Τρίπολη!!!</FONT> </b></p>
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<tr style="mso-yfti-irow: 1">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
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<p class=MsoNormal><FONT
size=4 color=#0000ff>Συμπληρώστε το
παρακάτω ερωτηματολόγιο, τηλεφωνήστε στο 2106009008
να ενημερωθείτε και κερδίστε 10% στο Detoxification
Program.</FONT>
</p>
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<p class=MsoNormal><b>
</b> </p>
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<tr style="mso-yfti-irow: 3">
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<p class=MsoNormal> </p>
</td>
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<tr style="mso-yfti-irow: 4">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
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0; mso-yfti-firstrow: yes; mso-yfti-lastrow: yes"
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<p class=MsoNormal><b>Εμφανίζετε κάποιο από τα παρακάτω συμπτώματα;</b></p>
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<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><b>NAI</b></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><b>OXI</b></p>
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<p class=MsoNormal><o:p></o:p></p>
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<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; BACKGROUND: black; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal><o:p> </o:p></p>
</td>
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<p class=MsoNormal><span style="DISPLAY: none; mso-hide: all"><o:p> </o:p></span></p>
<table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0
width="100%" style="WIDTH:
100%; mso-cellspacing: 0cm; mso-padding-alt: 0cm 0cm 0cm 0cm"
>
<tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes"
>
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>1. σωματική κούραση χωρίς προφανή λόγο;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q1" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q1" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 1">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>2. ακμή ή υπερβολική ξηρότητα στο δέρμα;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q2" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q2" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 2">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>3. ευαισθησία στον ήλιο;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q3" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q3" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 3">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>4. αδυναμία να συγκεντρωθείς (αφαιρείσαι ή
δυσκολεύεσαι να διαβάσεις);</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q4" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q4" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 4">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>5. σφίξιμο ή αίσθημα βάρους στο στήθος;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q5" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q5" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 5">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>6. γρήγορο ή ακανόνιστο καρδιακό ρυθμό;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q6" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q6" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 6">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>7. κρίση άγχους ή πανικού;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q7" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q7" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 7">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>8. να αισθάνεσαι ότι βρίσκεσαι έκτος τόπου και
χρόνου;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q8" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q8" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 8">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>9. αναπνευστικό συριγμό (σφύριγμα) χωρίς να είσαι
κρυωμένος;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q9" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q9" VALUE="no"></p>
</td>
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<tr style="mso-yfti-irow: 9">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>10. αίσθημα βάρους στο κεφάλι ή στα ιγμόρεια;</p>
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<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q10" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q10" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 10">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>11. συχνή ρινική καταρροή ή μπούκωμα;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q10" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q10" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 11">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>12. ερεθισμό στο λαιμό ή ευαισθησία;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q12" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q12" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 12">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>13. ερεθισμό στα μάτια;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q13" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q13" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 13">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>14. θαμπή όραση;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q14" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q14" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 14">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>15. απώλεια ή αλλαγή της αίσθησης της όσφρησης;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q15" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q15" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 15">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>16. απώλεια ή αλλαγή της γεύσης;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q16" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q16" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 16">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>17. μειωμένη σεξουαλική διάθεση;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q17" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q17" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 17">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>18. ίλιγγο ή ζαλάδα;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q18" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q18" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 18">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>19. εκνευρισμό
(ευέξαπτος - η , σε ένταση) χωρίς <FONT
color=#000000>σημαντικό</FONT>
λόγο;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q19" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q19" VALUE="no"></p>
</td>
</tr>
<tr style="mso-yfti-irow: 19; mso-yfti-lastrow: yes"
>
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal>20. ξαφνική απώλεια μαλλιών;</p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q20" VALUE="yes"></p>
</td>
<td width=25 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 18.75pt; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT TYPE="radio" NAME="q20" VALUE="no"></p>
</td>
</tr>
</table>
<table class=MsoNormalTable border=0 cellspacing=1 cellpadding=0
align=left width="100%" style="WIDTH:
100%;
mso-cellspacing:
.7pt; mso-padding-alt: 0cm 0cm 0cm 0cm; mso-table-lspace: 2.25pt; mso-table-rspace: 2.25pt; mso-table-anchor-vertical: paragraph; mso-table-anchor-horizontal: column; mso-table-left: left"
>
<tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes"
>
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
</tr>
<tr style="mso-yfti-irow: 1">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal><strong>Προσωπικά Στοιχεία</strong>*</p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
</tr>
<tr style="mso-yfti-irow: 2">
<td colspan=2 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; BACKGROUND: black; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal><o:p> </o:p></p>
</td>
</tr>
<tr style="mso-yfti-irow: 3">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
</tr>
<tr style="mso-yfti-irow: 4">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal>Όνοματεπώνυμο:<span style="COLOR: red">*</span><o:p></o:p></p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT NAME="FullName" id=FullName ></p>
</td>
</tr>
<tr style="mso-yfti-irow: 5">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal>Διεύθυνση:<o:p></o:p></p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT NAME="Address" id=Address ></p>
</td>
</tr>
<tr style="mso-yfti-irow: 6">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal>Πόλη:<o:p></o:p></p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT NAME="City" id=City
></p>
</td>
</tr>
<tr style="mso-yfti-irow: 7">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal>Τηλέφωνο:<span style="COLOR: red">*</span> <o:p></o:p></p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT NAME="PhoneNumber" id=PhoneNumber
></p>
</td>
</tr>
<tr style="mso-yfti-irow: 8">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal>E-Mail:<span style="COLOR: red">*</span><o:p></o:p></p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal><INPUT NAME="Email" id=Email
></p>
</td>
</tr>
<tr style="mso-yfti-irow: 9">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal>Μήνυμα:</p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
</tr>
<tr style="mso-yfti-irow: 10">
<td colspan=2 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal><TEXTAREA style="WIDTH: 300px" name=Message rows=6 cols=40></TEXTAREA></p>
</td>
</tr>
<tr style="mso-yfti-irow: 11">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
</tr>
<tr style="mso-yfti-irow: 12">
<td colspan=2 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal> <A
href="javascript:document.ContactForm.reset()"> <INPUT TYPE="submit" ACTION="http://www.detoxcenter.gr/includes/resources/postform.php" VALUE="Αποστολή" METHOD="post" NAME="Submit"
><INPUT TYPE="reset" VALUE="Επαναφορά" NAME="Reset"
id=Reset></A></p>
</td>
</tr>
<tr style="mso-yfti-irow: 13">
<td width="41%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 41%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
<td width="59%" style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; WIDTH: 59%; PADDING-TOP: 0cm"
>
<p class=MsoNormal> </p>
</td>
</tr>
<tr style="mso-yfti-irow: 14">
<td colspan=2 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p class=MsoNormal align=center style="TEXT-ALIGN: center"
>* Η εταιρία
μας δεσμεύεται ότι δεν πρόκειται να δημοσιευθούν ή χρησιμοποιηθούν <br>
τα στοιχεία σας για οποιοδήποτε σκοπό πλην της περάτωσης του εν λόγω
test. </p>
</td>
</tr>
<tr style="HEIGHT: 3.75pt; mso-yfti-irow: 15"
>
<td colspan=2 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm; HEIGHT: 3.75pt"
>
<p class=MsoNormal><span style="FONT-SIZE:
4pt; mso-bidi-font-size: 12.0pt"
><o:p> </o:p></span></p>
</td>
</tr>
<tr style="mso-yfti-irow: 16; mso-yfti-lastrow: yes"
>
<td colspan=2 style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
<p align=center style="TEXT-ALIGN: center"><b>Τα πεδία με (<span
style="COLOR: red">*</span>) πρέπει απαραίτητα να συμπληρωθούν για την
αποστολή της φόρμας.</b></p>
</td>
</tr>
</table>
</form>
</td>
</tr>
</table>
<p class=MsoNormal><o:p><FONT color=#ff0000> Εαν
επιθυμείτε διαγραφή απαντήστε με ΔΙΑΓΡΑΦΗ σε αυτό το
mail.</FONT></o:p></p>
</td>
</tr>
</table>
<p class=MsoNormal><o:p></o:p></p>
</td>
</tr>
<tr style="mso-yfti-irow: 1; mso-yfti-lastrow: yes">
<td style="PADDING-RIGHT: 0cm; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; PADDING-TOP: 0cm"
>
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href="http://www.detoxcenter.gr/newsletters/profile.php"
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</td>
</tr>
</table>
</div>
<p class=MsoNormal><o:p> </o:p></p>
</div>
</body>
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