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Parent or guardian's Name
Parent or guardian's Last Name
Patient's Name
Patient's Last Name (Paternal)
Patient's Last Name (Maternal)
Patient's Date of Birth
Telephone
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I would like an appointment with:
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-- Allergies
Dra. Iona Malinow
-- Cardiology
Dr. Rafael Villavicencio Camacho
-- Pediatric Surgery
Dr. Jorge Zequeira Díaz
-- Endocrinology
Dra. Adanette Wiscovitch Pagán
Dr. Luis Font Aponte
-- Gastroenterology
Dr. Leonardo Hormaza Laracuente
Dr. José Ordein Rodríguez
-- Hematology
Dr. Iván Pérez Dieppa
-- Nephrology
Dra. Nilka De Jesús
Dra. Auda Plaud González
-- Pneumology
Dr. Angel Colón Semidey
Dra. Carolina Miranda
-- Neurology
Dra. Mireya Bolo
Dra. Natalia Rodríguez Vázquez
-- Orthopedics
Dr. Humberto Guzmán Pérez
Dra. Lizzette Salgueiro
--Otorhinolaryngology
Dr. Héctor A. García Marrero
-- Psichology
Dra. Marta Loubriel
Dra. Alexandra Roura Arias
-- Psychiatry
Dr. Nicolás Hernández Sanabria
Dra. Beatriz Ramírez Ortiz
-- Rhematology
Dra. Enid del Valle de Jesús
Dra. Liza Vázquez Cobián
Comments
For emergencies, call 911. This form is not meant for emergencies.