FV Kids (English)

Patient-Information-3

heath-history

Is the Problem
Is your child receiving care from other health professionals?
Is or has your child ever experienced:
Have you ever visited a chiropractor?

pregnancy

Did you have invasive procedures (e.g., amniocentesis)?
Did the mother smoke during pregnancy?
Did you drink alcohol during pregnancy?
Did the mother take medication during pregnancy?
Did the mother use drugs during pregnancy?
Were you sick during pregnancy?
Type of birth

Childhood

Was your child breastfeed?
If breast-feeding, do you prefer to breast-feed on one side only?
Did the mother have difficulty breastfeeding?
Regurgitates or regurgitated?
Has he/she fallen off the bed, changing table or sofa?
Did your child?
Was there any difficulty in mother-child bonding?
Do you consider that your child sleeps well? Consider the quality of his/her sleep
Does he/she have behavioral problems?

In compliance with the Regulations UE 2016/679 27 April 2016, on the protection in relation to the treatmen and free circulation of personal data, and following the recommendations and instructions issued by the Spanish Agency for Data Protection (AEPD),

You are informed that: 

  • The personal data requested and provided will be incorporated into a privately owned file whose manager and recipient is Mediterraneo Quiropráctica. 
  • Only those data strictly necessary to properly manage the chiropractic service, contact and the issuance and treatment of invoices will be requested, and it may be necessary to collect personal data from third parties such as legal representatives, guardians or persons in charge designated for this purpose. 
  • All the data collected will have a commitment to confidentiality and the legally established security measures and under no circumstances will they be transferred or processed by third parties, physical or legal, (except our advice for billing), without prior consent of the patient, legal representative, tutor or person in charge, except in those cases where it is essential. - Once the relationship between Mediterraneo Quiropráctica and the patient has ended, the data will be archived and kept for 6 years from the last visit. After this period of time they will be destroyed or failing that they will be returned entirely to the patient or legal authorized. 

I express my consent that the data I provide can be included in the file of Mediterraneo Quiropráctica, in order to properly manage the chiropractic service, contact and treatment of invoices. I also declare that I have been informed of the possibility of exercising the rights of access, rectification, cancellation and opposition, requesting it in writing to Mediterraneo Quiropráctica 

 at Calle Frigiliana nº16 29003, Malaga or by email to info@mediterraneoquiropractica.com