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Enquiry Form   Medical Form   Photograph Making   Enquiry Form Medical Form Photograph Making     Tel.: +34 945 467 393 Fax: +34 971 254 686 KOSTENLOSER ANRUF MIT         Alle zur Verfügung gestellten Daten werden gemäß dem spanischen Datenschutzgesetz behandelt. Ihre Privatsphäre wird zu jederzeit gewahrt. * Bitte füllen Sie die Pflichtfelder aus. Medizinische Fragen. * Nachname: * Vornamen: * E-Mail-Adresse:    Telefon privat: * Telefonnummer, unter der Sie erreichbar sind: * Anschrift (Straße und Hausnummer): * Ort: * Postleitzahl: * Provincia: * Land:    Geschlecht: männlich    weiblich    Waren Sie schon in Mallorca? nein    ja    Wie haben Sie von der Mallorca Medical Group erfahren? Geburtsdatum:    1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Beruf: Ocupación: Name und Adresse des Hausarztes: Krankengeschichte. Es liegt in Ihrem eigenen Interesse, uns möglichst genau über Ihren Gesundheitszustand informieren. Welche Operation(en) wollen Sie durchführen lassen? Brust Body-Contour Genitalien Gesicht Hand/wiederaufbauend Botox Filler Mesolifting Peelings Happy-Lift-Behandlung andere Behandlungen Nähere Erläuterung (falls erforderlich): Leiden oder litten Sie an: Herz-Kreislauferkrankungen: nein    ja Bluthochdruck: nein    ja Epilepsie: nein    ja anderen ernsthaften Erkrankungen: nein    ja Wenn ja, machen Sie bitte nähere Angaben hierzu: Kommen in Ihrer Familie bestimmte Krankheiten vor: nein    ja Wenn ja, machen Sie bitte nähere Angaben hierzu: Haben Sie eine Mammografie durchführen lassen: nein    ja Wenn ja, machen Sie bitte nähere Angaben hierzu (Datum und Ergebnis): Bitte beantworten Sie die folgenden Fragen:   Rauchen Sie? nein    ja (wenn ja, wie viele Zigaretten pro Tag?) Sind Sie schwanger/stillen Sie? nein    ja Leiden Sie an Herpes? nein    ja Werden Sie mit Kortison behandelt? nein    ja Nehmen Sie Medikamente gegen Bluthochdruck? nein    ja Nehmen Sie Antibiotika? nein    ja Nehmen Sie Roaccutan? nein    ja Nehmen Sie Antikoagulantien? nein    ja Nehmen Sie Aspirin oder andere salizylsäurehaltige Medikamente? nein    ja Welche sonstige Medikamente nehmen Sie: Bestehen bei Ihnen Allergien, z. B. gegen Penicillin? nein    ja Wenn ja, wogegen? Wie viele Schwangerschaften hatten Sie? Bei Schwangerschaften: Wie hoch war Ihre höchste Gewichtszunahme? Wurde/n bei Ihnen ein/mehrere Kaiserschnitt/e durchgeführt? nein    ja Wenn ja, erläutern Sie bitte die Operationen und geben Sie an, wann der/die Kaiserschnitte durchgeführt wurden: Wurde bei Ihnen bereits eine Schönheitsoperation durchgeführt: nein    ja Wenn ja, erläutern Sie bitte die Operationen und geben Sie an, wann sie durchgeführt wurden: Raum für weitere Informationen: Größe: Gewicht: Haben Sie Ohrlöcher/Piercings? nein    ja Haben Sie Narben am Körper? nein    ja Wo? Gewünschtes Paket oder Unterkunft: 3* 4* 5* mi propia elección Geplanter Reisezeitraum:                von bis Benötigen Sie eine Finanzierung? nein    ja Ihre Nachricht: Terms and conditions. -------------------------------------------------- By means of the present document the visitors or users of this Webpage are informed about the general conditions that prevail for its use or consultation. The use and/or consultation of this page implies on the part of the users, the acceptance of all the conditions that are written in this document. The user user commits itself to make use of the services that are offered in this page Web according to the law, with the general conditions that specified, as well as the generally accepted moral and good standing. The user commits itself to compensate José I García Ceballos of Mallorca Medical Group, for any prejudice or damage that could cause derived of the use of this Website infringing these general conditions and/or the current law. This document also gives information about the particular conditions that prevail for the hiring of the services that are offered. José Ignacio García of the Mallorca Medical Group has the right to modify the conditions that are written herein without previous warning TERMS & CONDITIONS Welcome to Mallorca Medical Group. 1. All surgical and medical act have an associated risk, sometimes unpredictable, including dissatisfaction with the result. 2. We encourage you to clarify any doubts that you might have prior to your intervention or procedure. 3. Our liability is limited to the duty of care as third party facilitator and we will not be held responsible for any medical procedure disputes. 4. In the event of a dispute the parties put themselves under the jurisdiction of the court of law of Palma de Mallorca renouncing explicitly to their own law in force at the place of the contract. 5. The quote for surgery that we will supply will include the procedure that you and the surgeon have agreed. 6. Our medical treatment quote includes: a. Pre-flight advice and third party services between yourself and the surgeon. b. Transfer from and to the airport in Palma de Mallorca and transfers between your accommodation and surgery for the agreed treatments and medical appointments. c. Pre-operative and post-operative consultations with your surgeon, the surgery and hospital accommodation in Palma de Mallorca. d. Telephone/ e-mail support before, during and after your treatment. e. If accommodation is booked via us you will be billed exclusively the booking fee. f. The final hotel/accommodation bill will be issued by the hotel/accommodation company at the agreed price together with any extra costs that you might have incurred during your stay and settled at the end of your hotel stay. g. Free trasnportation is only offered for those patients visiting Mallorca for the medical or surgical treatment agreed and for any accommodation within 5km away from our surgery in C/ Murcia, nº 40, Palma de Mallorca. Airplane or boat tickets might be requested a s a proof of arrival and departure. 7. Quotes are valid for a 30 days period. 8. Upon confirmation of your medical treatment and accommodation, if applicable, a deposit of 10% of the quoted price for surgery is required together the full amount required for the accommodation reservation, with a signed booking form. The balance is payable, a minimum of 2weeks prior to your treatment. In the event of cancellation of a booking made by the client the 10% deposit will not be refunded .The directors may waive this figure at their discretion. The Directors reserve the right to cancel a booking and refund any payments paid.Since the accommodation company might vary from client to client the reservation fees for this concept may or not be refunded according to the accommodation company policies. 9. Our Medical/Surgical Treatment quotation will not include airfares to and from Palma de Mallorca , any unforeseen complications that may arise from the Surgery or any other cause. An example of this is additional stay in hospital, further unplanned Surgery or consultations with other specialists. These unforeseen complications treatment needs are not limited to the given examples. 10. We will communicate with you by telephone, e-mail or fax in respect of the planned treatment, body photographs and your visit to Palma de Mallorca . Your personal data will be dealt under the current Spanish Data Protection Statutory law. You should read carefully the contents of the legal text below tilted Data Protection. 11. We will act as third party between the surgeon and yourself. 12. In the unlikely event of any medical complication after surgery, no additional surgical fees will be charged for a period of one year after the date in which your treatment is completely finalised. Surgical fees should be understood as those charged by the surgeon for the treatment of the complication. In no case they should include the cost of treatments that require various sessions to obtain the desired result, nor remaining costs involved such as hospital fees, anaesthesia, accommodation, flight or medications. 13. Medical and surgical advice given in this web site is intended to be accurate and to the best of our knowledge, however any advice given should be discussed and thoroughly understood with the surgeon before proceeding with treatments. 14. Transfers are provided free of charge for treatments which cost is 1000€ or above. Privacy Policy In conformity with the Spanish Personal Data Protection Statutory Law 15/1999 and by filling in the present form, you give your explicit consent to the use of your personal data. Your details will be inscribed in a file property of Mr José Ignacio García Ceballos registered in the General Registry of the Spanish Data Protection Agency. Your data could be use only for medical diagnostic, treatment planning and scientific document publication and medical education. The user gives his/her explicit consent to be sent marketing communications via E-mail or another way . We would like to inform you that you can make use of your right of accessing, rectifiying, cancelling, and opposing your data by sending a letter including a passport /DNI (Spanish residents), via registered mail to the following address, as it is established in the above mentioned Statutory law: Dr. José I García Ceballos Departamento de Atención al Cliente en relación a LOPD (Ley Orgánica de Protección de Datos) C/Murcia nº40 07014- Palma de Mallorca España * Ich habe die allgemeinen Bedingungen gelesen und erkenne sie an.

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