Eduardo Anitua Institute > clinic > make an appointment

CLINIC

Make An Appointment

ASK FOR AN APPOINTMENT

Ask for an appointment by completing this form. We will contact you immediately.

*First Name:	*Surname:

Reason for your visit:

*Contact telephone:	*Contact e-mail:

City:	Country:

Day and time you would like to have an appointment at our clinic:

Day:		Visit time:

¿Is this your first appointment at our clinic?

Si No

¿How did you hear about our clinic?

¿How would you like to receive confirmation of the appointment?

By e-mail By telephone

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In compliance with Organic Law 15/1999 on the Protection of Personal Data we inform you that the data provided by you in the present formulary will be incorporated to the “patients” file owned by Clínica Eduardo Anitua with the aim of managing clinical appointments. If you wish to exercise your right to access, rectify, cancel or oppose the personal data provided you may do so by writing to Clínica Eduardo Anitua, c/ José María Cagigal, 19, 01007 Vitoria-Gasteiz (Spain) attaching a copy of your national ID


	home		CLINIC R + D POSTGRADUATE AND TRAINING CENTRE EDUARDO ANITUA		Facilities Technologies Treatments The Patient's Corner Professional Area Contact Make An Appointment Employment Opportunities	C/ Jose María Cagigal, 19 01007 Vitoria - Alava t.: +34 945 160 650 f.: +34 945 160 651 Vitoria, 04.02.2012	spanish english