Name Last Name Your Email Phone Date of Birth Gender MaleFemale Nationality Blood Type Medication Allergies Medical Conditions Surgical Procedures Do you take any antiplatelet or anticoagulant medications? YESNO If yes, please specify. Do you accept blood transfusion? YESNO Name and Contact of Emergency Person Phone of Emergency Contact I have read and expressly accept the privacy policy of U24 Health Services SL and the conditions of submitting this form I consent to the use of my data for the specified purposes I consent to the use of my personal data to receive informational communications and news about the activities of U24 Health Services SL