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All-on-4® Implant Placement
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Request a statementfor the tax return

Attach files:
Scanned copies of cash register receipts proving payment of rendered medical services
I confirm consent to personal data processing

Consent to personal
data processing

In pursuance of Federal Law No. 152-FZ dated 27 July 206 "Concerning Personal Data", I hereby consent to processing and retaining of my personal data and the data of the patient specified by me in the Form in order to provide me with an opportunity to submit a Request for a Statement on Medical Services Payment to the Inspectorate of the Federal Tax Service (hereinafter – "the Request") in soft copy. This consent is issued for an indefinite period of time.

Personal data processing shall mean collection (in the public Internet), classification, retention, specification (updating, alteration), utilization, destruction and any other actions (operations) with personal data.

Personal data shall mean any information relating to me as the subject of personal data specified in the Request by me.

Simultaneously, I consent and agree that the Company or other persons on its instruction will send messages to the phone number or e-mail address, or using other means of communication specified in the Request by me.

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