Clínica Barraquer

Centro oftalmolÓgico

45 años


Appointment schedule

Enter complete patient information.
Fields marked with an asterik ( * ) MUST be filled
Name: * Family name: *
Mail address*
Document type
Document N°.
¿Have you visited our institution?
Medical History N°.
Yes - No
City*
Country*
Phone indicative
Country ej.: Colombia = 57
City ej.: Bogotá = 1
Phone number 1 Phone number 2
Ext. Ext.
Mobile phone number Fax
Address
Choose a date range for your appointment:

Please select the initial date with at least (5) days of difference of today´s date and the final date with at least (3) days of difference of the initial date.

Initial Date:

Final Date:
Select the faculty members that have attended you or that you want to be attended by.
If you don´t have any preference don´t choose any or visit the faculty field in our web page to choose according to their speciality.


Comments

If you have any prepaid health service please use this field to include the company´s information (Company, plan and policy number) if you wish to use it.

With this form you will recieve a voucher with the appointment details, date, and time you should be in the Clinic.

This form will NOT solve any budget or procedure doubts, if you have any different request click here.

If the fields marked with an asterisk (
*) are not completed your request will NOT be processed.

Appointments Online