Appointment Request Form

    How can we help you?

     

     
     

    Medical information

    Have you been diagnosed with cancer?

     

     

    Do you have health insurance?

     

     

    Is there any information you would like to share to help us optimise your care?


     

    Do you have any medical report that you can share with us?

     

     

    All the documents you send us will be confidential and will only be used by our specialists to review your medical history and provide you with more personalised care.
     
    To do so, we require your authorisation to send this documentation for the processing of your data

     

     
     

    Type of appointment

    You can schedule an appointment for a second medical opinion or an initial remote consultation. Our patient care team will coordinate the appointment that best suits you.

     

     
     

    Contact details

    Patient's name(s)

    Surname(s)

    Email

    Telephone

    Date of birth

    Language

     

     
     

     

    I would like to receive emails with offers and news about this and other services *

     

    YesNo

     

    Data Controller: HC Hospitales, S.L. Purpose: To manage your appointment request. To send you information via newsletter, if you agree. Purpose: To manage your appointment request. To send you information via newsletter, if you agree. Data retention: Your data will be deleted once the requested information has been provided, unless you contract our services or ask us to contact you in the future. For newsletters, your data will be deleted when you unsubscribe. Recipients: We do not share your data with third parties. Your rights: You have the right to access, rectify and erase your personal data, as well as other rights explained in the additional information: https://clientes.prodat.es/privacidad/MLG/HCMARBELLA

     

    Oncology Consultants

    Dr. Cantero González, Alexandra
    Specialist in Medical Oncology
    Clinical Specialism in Lung Cancer and Cancer ImmunotherapySpecialist in Medical Oncology
    Clinical Dedication in Breast and Gynecological Cancer

    Dr. Ponce Aix, Santiago
    Medical Oncology Specialist
    Clinical Dedication in Lung Cancer
    Precision medicine
    Cancer immunotherapy

    Tel.: +34 952 908 628
    +34 609 148 799

    952908898 Oncology
    951829978 Diagnosis by imaging
    951829947 Gynecology
    952908897 Fertility
    951829947 Physiotherapy

     

       

       

      I agree to receive e-mails with offers and news about this and other services. *

      YesNo

       

      Responsible: HC Hospitales, S.L. Purpose: Managing the appointment process. Sending you information by newsletter, upon your acceptance. Duration: The data is deleted once the information has been provided to you, unless you contract our services or request us to contact you in the future. With regard to the newsletter, the data is deleted when you unsubscribe from it. Recipients: We do not disclose your data to any other party. Rights: To access, rectify, and delete your data, as well as further rights explained in the additional information webpage: https://clientes.prodat.es/privacidad/MLG/HCMARBELLA

       

      Patient Services

      • 900877454 Call Center
      • 609 148 799
      • 952908898 Oncology
      • 951829947 Gynecology
      • 952908897 Fertility
      • 952908131 Hospital pharmacy

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