Suggestions and compliments

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Patient's data

Name*

Surname*

Identification document or Passaport number*

Phone number and/or Email*

Date of birth (DD/MM/YY)

Address

Number of your healthcare insurance card

Personal data of the person contacting us for feedback in the name of a third party (if applicable)

If you are completing this form on behalf of someone else, please provide your personal details below:

Name

Surname

Identification document or Passaport number

Phone number and/or Email

Date of birth (DD/MM/YY)

Address

Number of your healthcare insurance card

Please state your suggestion or praise*

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. *