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Verdeza enhances the lives of its residents and provides peace of mind for the whole family

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Verdeza enhances the lives of its residents and provides peace of mind for the whole family

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Verdeza enhances the lives of its residents and provides peace of mind for the whole family

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Verdeza enhances the lives of its residents and provides peace of mind for the whole family

Admission Evaluation for Short term Stays

In order to give the best quality care possible to the patient, we would appreciate to complete the following medical information.

Fields marked with * are required.

Personal information

Arrival Details (only for patients or guests coming from abroad)

Personal Pathologic History









Medication

Personal Non Pathologic History



FOOD ALLERGIES:

Surgery information or medical procedure (if applies)



Select your special needs:




Does the patient have any cognitive impairment?





What is the functional status?





Reservation details


Extra person in the room (non patient)

Observations:

Please draw your signature:

Please solve the following operation:

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Verdeza

We are located at Trejos Montealegre neighborhood, Escazú, 1km west from Walmart

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Verdeza | pregunta@verdeza.com | Site Map | Privacy Policies | Work Opportunities

Trejos Montealegre, Escazú, 1km west from Walmart

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