Name:
 
 
Age:
  
 
E-mail
  
 
    (*) It is essential to put your e-mail and/or telephone number so that we can respond to your consultation.
 
Telephone
  
 
Province / State
  
 
Prior medications and surgeries:
  
 
Country
  
 
Years of sterility:
  
 
Previous sterility studies
 
 
Previous treatments
 
 
Previous pregnancies
  
 
More information
  
 
    In fulfilment of the "Ley Organica 15/1999", 13th of December, Privacy Protection of Personal Information, we inform you that all personal information given on this Web Page will be added to an informatic data base in the IOM INSTITUTO, S.L., exclusively to make the services solicited by the users easier. Likewise, the user always has rights to the information's access, correction, cancellation and opposition at his/her disposal which can be solicited by e-mail to info@iominsituto.com or by conventional mail to the address: Calle Via Augusta 249 bajos 08017, Barcelona.
 
   

If you want to receive information, check the following box:

I authorize to receive any related information to the activities, products or services of this site by e-mail, postal mail or fax.
 
 
   
 
Fertilab, Institut Català de Fertilitat. Diseño web: J.A.Sancho - SITEMAP