Contact Us: infosalud@healthincuba.com
ES
 
 
 
It is necessary to request a medical treatment program, that you have sent us an attached summary of your medical history, made by the attending physician. We understand as updated a maximum of 6 months of realized.

Dear user, all fields of this form are mandatory, we ask that you fill them all out for a satisfactory sending of the form.
 
Name:

 
Last name:
Age:

 
Sex:
Country:

City:
Email:

 
Phone:
Request:
Disease history:
Previous tests:
(If you do not have an analysis you must specify that you do not have any)

Indicated treatment:
(If you never counted on some type of treatment, you must specify it)
 
 
 
 

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