Programa de Pacientes Disfruto mi Salud
|   Language:   Spanish  |         Admission for patients -
The information provided on this site is not a substitute, nor does it constitute medical or professional advice of any kind.
Patient Inscription
Enter the information requested (Fields marked with * are required fields)
Country *:
Name * :
First last name * :
Second last name (optional) :
Gender *:
Male    Female  
Date of birth *:
Document type *:
ID Passport Foreign ID DPI Under Age
Identity Card Number*:
(Enter your identity card number. Example: 0-0000-0000)
Address:
Mobile/Cell Phone :
(Enter your mobile/cell phone number. Example: 88888888 )
Telephone:
E-mail :
(Enter your email. Example: user@example.com)
How did you hear about celebrate life program? *
Which drugstore? *
Add the products that you consume * :
Name of the Doctor who prescribed you * :
Does not indicate doctor:
ADDED PRODUCTS
Remove Doctor Medicine
No data
Do you want to include your caregiver's information?
Yes   |   No 
Create your password to access your personal account *:
Confirm your password to access your personal account *:
With your card and this password, you can check your account statement by entering the private section that you will find in the upper right of this page.
Do you have a AZCode?
An AZ-CODE is a code (of numbers) that you may have received from your doctor to benefit from an initiation of treatment of your newly prescribed medication. If so, enter it here and request it at the pharmacy
ADDED AZCODES
Remove AZCode Other Doctor (AZcode)
No data
By clicking on the button " SEND" you accept the See Terms and Conditions of this patient program:
Yes   |   No 

See Terms and Conditions
By clicking on the button " SEND" you accept the Informed Consent of this patient program:
Yes   |   No 

Informed Consent
By clicking on the submit button, you will be a patient enrolled in the program, please click on the link or link you will receive by email or text message (SMS) so you can receive the benefit of the exchanges. Make sure the email has not fallen into your spam or spam tray.
Your data will not be shared with third parties. They will only be used for respective communications of the program.