Farmaten

Are you making the enquiry for yourself? (mandatory)

Yes No

Sex (mandatory)

Male Female

Are you pregnant or breastfeeding? (mandatory)

Yes No

Do you take contraceptives? (mandatory)

Yes No

Allergy or adverse reactions to medications? (mandatory)

Yes No

Specify

Other type of allergy or intolerance? (mandatory)

Yes No

Specify

Are you currently taking any medication? (mandatory)

Yes No

Which one?

If you have had or have any of these diseases, please tick:

Diabetes Arthritis Anemia Cancer High blood pressure Hepatitis Kidney disease Epilepsy Heart disease, heart damage

Other diseases:

Have you been hospitalized in the last two years? (mandatory)

Yes No

Why?

Indicate the health problem that is the reason for the consultation or the medication you want to be informed about (mandatory)

Specify how long you have had the problem and if you have used any type of medication or alternative therapy for it (mandatory)

Observations; add all the information you consider necessary

I have read and accept the processing of my personal data.

Responsible of the Treatment	BASILIO VALLADARES SALMERÓN. Avd. Las Palmeras, 53 Finca España 38205 San Cristóbal de La Laguna 922 646 816 – 922 661 371 Ext. 1 The information will be treated with the sole purpose of providing a better professional service, attending to the requests from our clients.
Purpose	To respond to requests from our clients online
Legitimation of the treatment	Informed consent collected through checkbox
“Recipients ” (of assignments or transfers)	No transfers of data will be made, except by legal obligation, except for legal obligation or in case of necessity. No international data transfers are planned.
“Rights” (of the interested parties)	You can exercise your legal rights by writing to the email address provided by our Data Protection Officer: dpd@canadat.es Attaching a copy of your identity document or equivalent, and outlining the right you wish to exercise. Right to withdraw consent given Right to file a claim with the Control Authority https://www.aepd.es/ More information on the treatment of personal data in: https://www.farmaten.com/en/info/privacy-policy.html

Cookie name	Provider	Purpose	Expiry
cookiesplus	farmaten.com	Stores your cookie preferences.	1 year
PrestaShop-#	farmaten.com	This cookie helps keep user sessions open while they are visiting a website, and help them make orders and many more operations such as: cookie add date, selected language, used currency, last product category visited, last seen products, client identification, name, first name, encrypted password, email linked to the account, shopping cart identification.	480 hours

Cookie name	Provider	Purpose	Expiry
collect	Google	It is used to send data to Google Analytics about the visitor's device and its behavior. Track the visitor across devices and marketing channels.	Session
r/collect	Google	It is used to send data to Google Analytics about the visitor's device and its behavior. Track the visitor across devices and marketing channels.	Session
_ga	Google	Registers a unique ID that is used to generate statistical data on how the visitor uses the website.	2 years
_gat	Google	Used by Google Analytics to throttle request rate	1 day
_gat_gtag_UA_*	Google	Used to throttle request rate.	1 minute
_ga_#	Google	Used by Google Analytics to collect data on the number of times a user has visited the website as well as dates for the first and most recent visit.	2 years
_gd#	Google	This is a Google Analytics Session cookie used to generate statistical data on how you use the website which is removed when you quit your browser.	Session
_gid	Google	Registers a unique ID that is used to generate statistical data on how the visitor uses the website.	1 day

Cookie name	Provider	Purpose	Expiry
ads/ga-audiences	Google	These cookies are used by Google AdWords to re-engage visitors that are likely to convert to customers based on the visitor’s online behaviour across websites.	Session
fr	Facebook	Used by Facebook to deliver a series of advertisement products such as real time bidding from third party advertisers.	3 months
IDE	doubleclick.net	Used by Google DoubleClick to register and report the website user's actions after viewing or clicking one of the advertiser's ads with the purpose of measuring the efficacy of an ad and to present targeted ads to the user.	1 year
NID	Google	Registers a unique ID that identifies a returning user's device. The ID is used for targeted ads.	6 months
sib_cuid	Sendinblue	Collects information on the user's website navigation and preferences - This is used to target potential newsletter based upon this information.	1 year
tr	Facebook	Used by Facebook to deliver a series of advertisement products such as real time bidding from third party advertisers.	Session
_fbp	Facebook	Used by Facebook to deliver a series of advertisement products such as real time bidding from third party advertisers.	3 months

Pharmaceutical advice