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PMH Fertility Form

Please complete most of the questions, some are not related to your situation, please answer those that are familiar to you and easy to answer, questions with an asterisk (*) are mandatory to answer at the end of this questionnaire, press submit.
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    • MM slash DD slash YYYY
    • Kg
    • Cm
    • Emergency Contact Information

    • About the medical consultation

    • Background

      Answer the following questions: (ONLY IF THEY APPLY TO YOU)
    • OBGYN Background

    • (How many days does your period present)
    • DD slash MM slash YYYY
      (First day of your last period started)
    • DD slash MM slash YYYY
    • Do you have any symptoms?

    • Your personal data is collected by the staff of “PUNTA MITA HOSPITAL”, solely and exclusively to be able to register it, Personal data (Passport, name, address, among others.) and sensitive personal data (religion, sexual preference, state of health , among others.) obtained through any healthcare and/or administrative care process by “PUNTA MITA HOSPITAL” personnel, are confidential and will be protected, incorporated and processed in the management system called Personal Data of “PUNTA MITA HOSPITAL ”, through administrative, physical and technical security measures that guarantee its confidentiality and integrity. The purpose of such treatment of your personal and sensitive data is to grant and guarantee the right to health, through efficient medical, administrative and legal procedures, which allow users to reduce waiting time, improve the quality of services and provide timely and accurate medical care.

      Likewise, users in health matters are informed that the personal and sensitive data provided to “PUNTA MITA HOSPITAL” will be protected and managed by this company; and, they will be transferred in accordance with the ethical and legal security principles that guarantee their proper use and protection; likewise, such transfer will be made considering the original principle of the user’s health; Said transfer will be made to natural and legal persons, as long as the medical service in question cannot be granted by it, because it requires specialized medical attention, hospital referral, laboratory analysis, administrative or statistical procedures; or, when required by the competent authority in the exercise of its powers.

      If you do not want your personal data to be processed for the stated purpose, we recommend that you express your refusal to the administrative area by calling (329) 688 00 59 ext. 200, where they can guide you on the matter. This privacy notice is simplified. To consult the comprehensive privacy notice, you can do so through the following electronic link: www.puntamitahospital.com/privacy-policy/

    +52 (329) 688 00 59 / ext 606

    +1 (310) 994 78 30

    pmhfertility@puntamitahospital.com

    Privacy Policy © 2022 Punta Mita Fertility Center

    +52 (329) 688 00 59 / ext 606

    +1  (310) 994 78 30

    pmhfertility@puntamitahospital.com

    Privacy Policy © 2022 Punta Mita Fertility Center