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New flight offer to Cuba, Tampa-Havana and coming soon Miami-Havana.
  
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CUSTOMIZED MEDICAL ATTENTION

The following formular makes it possible for you to send to our medical personnel the main symptoms you are suffering from. You can also fill in for a friend.

Once submitted one of our staff members will contact you at once to see you through the rest of the process.

Note: If another person then the patient will be paying the services, please specify this in the comments section.
The fields with an * are mandatory

General Information about the patient:
 
*First and second name:
*Age:
*Gender:

Country of residence:
City of residence:
*Email:
*Repeat Email:
Arrival date (dd/mm/yyyy):
 
Return date (dd/mm/yyyy):
 

Data about the illness or disorder you are suffering from:
 
* Brief explanation of the symptoms and the name of the disorder in case you are aware of it.

The medical treatment you want to receive in Cuba:
Ways of payment you prefer:
 
Way of payment:

Additional comments about payments:
Request for accommodation:
(Only for patients with ambulatory treatments or their companions)
 
Type of accommodation:
Adults:
Children (0 - 12 años):
Additional comments:
 
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  Premios obtenidos:
Premio espacio 2004. Asociacion Cubana de Comunicadores Sociales
 
 
Updated: 05/09/2011
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