Users

If you want to request a place at the centre, please fill in the fields in the following form. After we have received you submission, we will contact you as soon as possible.

Data of patiente

Name and surname

Place of birth

Date of Birth

Age

National Identification Number

Social Security Number

Private insurance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Data of the responsible person

Name and surname

Address

Telephone number

 

 

 

 

At A Coruña, 12345678910111213141516171819202122232425262728293031 of EneroFebreroMarzoAbrilMayoJunioJulioAgostoSeptiembreOctubreNoviembreDiciembre of 2012

Signed.

At the Gerontological Complex 'La Milagrosa' we guarantee the privacy and personal data protection of all of our customers. Our web site does not automatically recognise any personal data of our visitors. In those cases that any visitor request information about our product or services or even try to arrange any incidence, complain, suggestion, claim or demand through the forms present at our web page, our system will only recollect the necessary personal data to be able to contact you about the request.

All this data is treated with absolute confidentiality and it is only used for the specified purposes according the the Spanish legislation in special with the Organic Law about Data Protection.