Complaints

* Fields are required

Patient's data

Name*

Surname*

Identity document/passport*

Phone number and/or Email*

Date of birth (DD/MM/YY)

Address

Number of your healthcare insurance card

If submitting a complaint or claim on behalf of a third person :

If you are filling in this form on behalf of a third person, please provide your own personal data

Your name

Your surname

Your identity document/passport

Your phone number and/or Email

Your date of birth (DD/MM/YY)

Your address

Number of your healthcare insurance card

State here the reason for your complaint or claim*

The sending person gives their consent for the AECT-Hospital de Cerdanya to process their data - in order to respond to their request - in accordance with Regulation (EU) 2016/679, of April 27, 2016. Here you can access the full privacy policy. *