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Documents

Below you will find documents in PDF format to be downloaded, which must be signed, scanned, and sent by e-mail, according to the instructions received during the consultation and your particular case. If you have any questions, please do not hesitate to contact Dr. Mantilla.

All Rights Reserved. © 2019. Juan Camilo Mantilla G.

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Documents

Confidentiality  Agreement (Parents): 

Download this document in the event that any of the parents of the minor attending the consultation, were unable to attend the assessment session. This document must be signed by both parents. Once completed, it can be sent via email or by filling out the Personal Data Questionnaire.

Confidentiality Agreement (Online): 

Download this document in case of starting any type of therapeutic process online.

Case History Request: 

Colombian law is cautious in the protection and confidentiality of clinical records. Resolution 1995 of 1999 states that the case record is a private document, subject to reservation, that can only be known by third parties, prior authorization of the patient or in cases provided by law, so it is necessary to comply with the requirements mentioned below for your request:

 

  • ID Copy
  • Case History Request Form, duly signed and indicating the reason for request.

 

Please send this documents by email.

 

Below you will find the Case History Request Form:

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