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Personal Data Input

This section is exclusively for those persons who have been formally accepted as patients by Dr. Mantilla.

 

In order to proceed, it is important that you have a Gmail account and have completed the authentication process, before clicking to complete the corresponding questionnaire.

 

It is important that you have PDF files at hand, one with a photo of your face, and the other with both sides of your ID. If necessary, provide PDF files with evaluations, medical exams, psychiatric tests, psychological tests or documents that you consider important for your process.

 

In the case of you are a minor, the identity documents of both parents must also be provided through a PDF file.

 

It is important that you find a quiet and suitable space to complete this process, where you avoid interruptions and have good Internet access. You should have enough time (minimum one hour) to complete the questionnaire.

 

All information you provide is confidential and will not be shared with any individual or entity. The purpose of this is to effectively comply with the assessment and formulation phase of your case.

 

Below you will find a series of online links that will refer you to the corresponding Personal Data Questionnaire, which must be filled out in its entirety, as part of the therapeutic process it's being carried out.

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Personal Data Input

PERSONAL DATA QUESTIONNAIRE

 (ADULTS)

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PERSONAL DATA QUESTIONNAIRE

 (MINORS)