Booklet and Guide Orders
Information in this form is collected to handle your requests, thus this collection is necessary.
We hereby inform you that this data may also be collected or received by third parties, including public authorities, our company’subcontractors . These data will be kept for a duration of 10 years. If necessary, they may be transferred for storage purposes to servers located in countries outside the European Union, under conditions guaranteeing its protection and security and guaranteeing your rights. These data will be protected by the « Privacy Shield », in force since 2006 August 1st.

By filling in this form, you accept the processing of the data recorded on this occasion under the conditions described above. You have the right to withdraw your consent to the processing of your personal data at any time without prejudice to the lawfulness of the data processing carried out before the withdrawal of your consent.

In accordance with the European Data Protection Act, you have the right to request access to this data and/or its rectification or erasure, as well as the right to request the limitation of its processing, the portability of the data and the right to oppose its processing. You may exercise these rights by addressing the company : You also have the right to submit any claims related to these rights to your local Data Protection Authority.
First Name *
Name *
Status *
Country *
City and Zip Code *
Address (Hospital and/or Street *
e-mail *
Phone Number (+ international format) *
Patient guides order
Physician guides order
Your comments
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy