Covid-19 Vaccine – BRCR

Call Center: +1 787 331 4275

| Email: info@brcrpatients.com

Call center +17873314275
Email: info@brcrpatients.com

New Orleans

Covid-19 Vaccine

Males and females over 18 years of age who have received the complete schedule of vaccines against Covid-19.

Age: +18

If you want to participate, fill out the form below in this section

If you want to participate, fill out
the form below in this section

FILL THIS FORM FOR PARTICIPATION

This information is completely confidential

Patient First Name

Patient Last Name

Country

City

Patient Year of Birth

Zip/Postal Code

Contact Phone

Extension (If applicable)

Alternate Phone Number

Diagnostic

May we leave a message?

May we leave a message?

YES, leave a message

YES, leave a message

NO

NO

I have read about confidentiality and privacy

I have read about confidentiality and privacy.

We are BOCA

HOPE for patients, family and future generations

HOPE for patients, family and
future generations

Florida, USA

8200 W Sunrise Blvd – Suite D2
FL 33322
Phone: +1 888 745 2727

San Juan - PR

Ashford Medical Center
29 Washington Street suite 310
San Juan, PR 00907
Phone +561 447 0614 Ext. 504

CDMX, México

Sur 132 No. 108 Suite 601-605 Col. Las Américas CP 01120
Phone: + 52 55 2614 5118

Costa Rica

Contact our Headquarter
Phone +1 888 745 2727

© BRCR Global. All Rights Reserved | Terms Of Use | Privacy Policy

© BRCR Global. All Rights Reserved
Terms Of Use | Privacy Policy