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RESEARCH AND DEVELOPMENT

REQUEST FORM FOR CUSTOM IMPLANTS

    PATIENT DATA






    DOCTOR'S INFORMATION





    DESCRIPTION OF THE TYPE OF CUSTOM IMPLANT





    Computed axial tomography with images in DICOM format. This will be taken in accordance with the document “3D medical image acquisition protocol”, which is available by clicking here. The quality of the study, necessary to carry out a reconstruction, will be evaluated when the aforementioned information is received.

    ADDRESS

    Polígono Industrial el oliveral
    Calle C, S/N
    46190, Ribarroja del Turia
    Valencia España

    E-MAIL ADDRESS

    info@tequir.com

    Telephone

    +34 961 668 795

    SOCIAL NETWORKS

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    Basic information on data protection:

    The personal data you provide us about yourself will be processed only with your consent, when signing this form. You must have authorization from the patient to transfer their data to us.
    The data provided will be transferred to third parties, only in cases where we are legally obliged to do so and it is essential to respond to your request.
    You have the right to ask us to access your data, correct it or delete it, you can also ask us to limit its processing, oppose it and the portability of your data, by contacting our postal address or info@tequir.com

    IMPORTANT

    Please, before sending the form, make sure you have filled out all the fields and attach, as indicated on the website, the documentation obtained in accordance with the 3D medical image acquisition protocol available at the following link.