Cancel an appointment

Appointment

If you wish to cancel an appointment with one of our paediatricians or paediatric specialists, please fill out this form indicating the date of the appointment.

If you need to request a new appointment, please leave your information and we will schedule it.

Sending this form entails acceptance of our Privacy Policy.

    CHILD’S FULL NAME(*)

    E-mail (*)

    SUBJECT

    SPECIALIST

    SPECIALISATION

    DATE CANCELLED

    WOULD YOU LIKE US TO GET IN TOUCH WITH YOU TO SCHEDULE A NEW APPOINTMENT?

    YesNo

    DO YOU PREFER BEING CONTACTED BY EMAIL OR TELEPHONE?

    E-mailTelephone number

    CONTACT TELEPHONE(S) (*):

    NOTES

    I have read and accept the Data Protection clause


    contacte

    Ens trobaràs a:

    CONSULTA AMBULATÒRIA

    • C/ Anglí, 31, 2º
      08017 Barcelona
      See Google Maps
    • 93 205 57 57
    • 93 205 05 23
    • Hospital Universitari Quirón Dexeus
      C/ Sabino de Arana, 5-19, planta 0, Consulta 4
      08028 Barcelona
      See Google Maps
    • 93 546 01 26
    • 93 546 01 74

    URGÈNCIES

    • Hospital Universitari Quirón Dexeus
      C/ Sabino de Arana, 5-19
      08028 Barcelona

    FORMULARI DE CONTACTE

      Nom i cognoms (*)

      E-mail (*)

      Assumpte

      Missatge

      Telèfon de contacte (*)

      He llegit i accepto la Clàusula de Protecció de Dades


      contacte