SOLICITUD DE NUEVO INGRESO

¿Tienes un No. de folio?, ingresalo aquí

Nuevo Ingreso

Domicilio Particular

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form

Datos Institución

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form

Domicilio Consultorio

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form

Tipo de Práctica

Grupo Multidisciplinario
Grupo Individual Especializado
Consulta Privada
Consultorio Médico Compartido
Investigación
Docencia Universitaria
Industria
Médico de Base
Jubilado
Gobierno (Salud Pública)
Otro
Debes seleccionar al menos 1 tipo de práctica.

¿Consiste su práctica en 50% o más:

Endocrinología General
Endocrinología Quirúrgica
Endocrinología Pediátrica
Diabetes y Metabolismo
Endocrinología Reproductiva
Otro
Debes seleccionar al menos una práctica con 50% de experiencia o más.

Áreas de Mayor Interés Clínica.

Selecciona máximo 5 opciones.

Transtornos Suprarrenales
Diabetes Mellitus
Síndrome Endócrinos Ectópicos Metabolicos
Endocrinología Geriátrica
Hipertensión
Menopausia
Neurocirugía
Nutrición
Osteoporosis
Enfermedades de la Paratiroides Poliquístico
Pedriatría
Reproductiva
Enfermedades Tiroideas
Cáncer
Enfermedad del Embarazo
Endocrinología General y Metabolismo
Transtornos del Crecimiento
Transtornos de Lípidos
Metabolismo Óseo
Medicina Nuclear
Obesidad
Enfermedades de la Paratiroides Poliquístico
Trastornos hipofisarios
Síndrome de ovarios poliquísticos
Cirugía
Otro
Debes seleccionar al menos 1 Area de Interés.
Debes seleccionar menos de 5 Areas de Interés.
Es obligatorio capturar todos los datos del formulario.


Enviar