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