Medical summary form BMO
Alcanza tus objetivos de salud y bienestar con bestmedicaloption, pronto te contactaremos
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Your full name / Tu nombre completo
Phone number (with country code) / Tu teléfono (con indicativo de país) *
email / correo electronico
Your age / Tu edad *
Your Nationality / Tu Nacionalidad *
Your weight / Tu peso *
Your Height / Tu altura *
Any illness? / Alguna enfermedad? *
Do you take any medication? / Tomas algún medicamento? *
Do you have any allergy? / Sufres de alguna alergia? *
Have you had previous surgeries? / Has tenido cirugías? *
What´s your goal? / Cual es tu proposito?  *
Required
We are commited to protect and respect your privacy. We´ll only use your information to manage your account and provide the information and services requested / Estamos comprometido con el respeto y protección de tus datos, estos solo serán usados para facilitar la prestación de los servicios requeridos.
By clicking submit below, I expressly authorize Best Medical Option to deliver to my phone number and/or email address, communications using an automatic telephone dialing system, an artificial and/or a prerecorded voice by phone calls, text messages, voicemails, and emails advertising its services, products, promotions, appointment, account information. I can unsubscribe or provide notice to Best Medical Option that I would like to opt-out at anytime. I understand I'm not required to opt in to purchase goods or services. I have read the privacy policy  and the terms of service and I accept and agree with them. / Al dar click en enviar, autorizas a Best Medical Option a contactarte por teléfono o correo electrónico para comunicaciones, promociones o información de tu cuenta. He leído la política de privacidad y términos de servicio y acepto y estoy de acuerdo con ellos.
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