• general
• pharmaceutical
• specialist

Name	*	Name	*
Address		C.P./Zip
City		State/Province
Email	*	Telephone
Comments

Name	*	Name	*
Address		C.P./Zip
City		State/Province
Email	*	Telephone
	Do you work in a drugstore? Yes No
Data from the drugstore where you work Position     Name of drugstore NIF/CIF Address C.P./Zip City State/Province Email Telephone
Comments

Name	*	Name	*
Address		C.P./Zip
City		State/Province
Email	*	Telephone
Business		Speciality	Select speciality Dermatology Surgery Geriatrics Business medicine General medicine Paediatrics Other
Comments

In accordance with the Organic Law 15/1999 of December 13, Protection of Personal Data, reporting to people who complete this form, which they and introduced the data will be part of a computer file ownership of SeSDerma SL, previously reported to the Data Protection Agency, created in order to provide adequately for our services and / or inform you about issues or projects related to our company and / or technical-scientific or professional, health and / or pharmacist who believe may be of interest to them.

By sending this form, the sender gives his consent to the automated processing of data included in it. Also, you consent to their personal data are integrated into the files of companies that are part of our group business, SeSDerma, in order to keep you informed of developments and related services SeSDerma Group. SeSDerma SL, assures confidentiality of their personal data and ensures that in no case will be transferred to third parties outside our group.

Fields marked with an asterisk (*) are required. You can exercise their rights of access, cancellation and opposition, from SeSDerma SL, domiciled in the street Massamagrell, 3, 46138, Rafelbuñol (Valencia), or to our e-mail: legal@sesderma.com