LeRo Teralava S.L.U., Avda. Amsterdam, 8
E-38650 Los Cristianos / Arona / Tenerife / España
Tel. (+34) 922 750 289
Fax (+34) 922 750 283
 
ONLINE Booking Nursing care Prices & Infos We about us Disclaimer/Terms of business
 
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LeRo - Tenerife - ONLINE Booking Nursing care
NEWSWORTHY
Book professional nursing care with us! back
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Por favor utilice uno de estos tres idiomas para contactarnos.
Please use one of the following three languages to contact us.
Bitte nutzen Sie eine dieser drei Korrespondenzsprachen zur Kontaktaufnahme.

Dear Customer,
   
To avoid misunderstandings on both sides, please fill in the form below as far as completely possible. The BOLD marked fields are indispensable. To assist in the organisation of bookings, please confirm your booking minimum 2 weeks before arrival date.
Personal Dates (client)
Mr/Ms
First name

To stop confusions that may occur with surnames that are similar or the same, we kindly must ask you to fill in the square with your first name. We thank you for your understanding and apologize for any inconvenience.
Last name
Street
Street (additional)
 
Country
please choose your country
Postal code
Town
Town (additional)
 
Phone
Fax
 
Passport number  
more informations  
eMail address
Repeat eMail address
Make a reservation for nursing care
  The form is only for scheduling nursing care. The information taken should be understood as reservation for nursing care. We endeavour to take into account your preferences for the dates to begin treatment and to work them into our schedule to the extent possible. However, we cannot guarantee the exact time of day that the treatment will begin. All patient information is made available only to our medical personnel and is treated as confidential in every respect.
Date of Arrival
example: 10.03.2012
Date of Departure
example: 28.03.2012
Hotelname
Your approximate weight   under 80 kg 80 - 100 kg over 100 kg
Kind of disability  
Paraplegia
Tetraplegia
Hemiplegia (paralysis on one side)
Some other kind of brain damage
Blindness
Deafness
Amputation (leg)
Amputation (arm)
Walking impediment
or other  
What other medical aids OF YOUR OWN are you bringing along?  
Napkins, inserts for incontinence, etc.
Bladder catheter
Urinal condom
Anti-thrombosis stockings
Stomach tube
Hearing aid
Brindley (electronic voiding of the bladder / evacuation of the bowels)
Stoma (artificial bowel outlet)
Stoma (artificial bladder outlet)
and / or other  
click here, if YES Schedule of appointments: ARRIVAL DATE
Which treatments should be performed at this appointment?
Start of treatment: time
time NOTICE: time of day subject to change!
approximate time required h min
click here, if YES Schedule of appointments: e.g. MORNING
Which treatments should be performed at this appointment?
Start of treatment: date
example: 13.03.2012
Start of treatment: time
h NOTICE: time of day subject to change!
approximate time required h min
How often should this treatment be performed?
once every Sunday
daily every Monday
every other day every Tuesday
every third day every Wednesday
weekly every Thursday
  every Friday
  every Saturday
click here, if YES Schedule of appointments: e.g. MIDDAY
Which treatments should be performed at this appointment?
Start of treatment: date
example: 13.03.2012
Start of treatment: time
h NOTICE: time of day subject to change!
approximate time required h min
How often should this treatment be performed?
once every Sunday
daily every Monday
every other day every Tuesday
every third day every Wednesday
weekly every Thursday
  every Friday
  every Saturday
click here, if YES Schedule of appointments: e.g. EVENING
Which treatments should be performed at this appointment?
Start of treatment: date
example: 13.03.2012
Start of treatment: time
h NOTICE: time of day subject to change!
approximate time required h min
How often should this treatment be performed?
once every Sunday
daily every Monday
every other day every Tuesday
every third day every Wednesday
weekly every Thursday
  every Friday
  every Saturday
click here, if YES Schedule of appointments: e.g. NIGHT
Which treatments should be performed at this appointment?
Start of treatment: date
example: 13.03.2012
Start of treatment: time
h NOTICE: time of day subject to change!
approximate time required h min

How often should this treatment be performed?

once every Sunday
daily every Monday
every other day every Tuesday
every third day every Wednesday
weekly every Thursday
  every Friday
  every Saturday
Terms of business
I accept the terms of business
Send the form ...  
data privacy protection  

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