IBADE Especialista en Endocrinología y Nutrición en Barcelona

TELEMATIC VISIT FORM

Telematic visit form

*PATIENT name:

*PATIENT Surnames:

*Sex:

Man

Women

*Birthdate:

* DAYS

*Telephone:

*PATIENT Email

*Confirm email:

Email from which the payment was made (if the payment was made by someone else)

Date on which payment for the visit was made

*Population:

*Requested professional

* Requested query type

* Is this your first visit with this professional?

Inclusion

Al marcar, acepto la Privacy Policy y el legal warning.

*Required fields

Contact

4:00 p.m.-7:30 p.m.

Address

C/Calabria 241, Bajos 08029 Barcelona

Registration Code of Centers, Services and

Health Establishments of Catalonia: E08702641