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Remember to verify all your information, WE CANNOT MAKE CHANGES, so please keep in mind the dates from when you enter Spain until you finish your studies.

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PURCHASE HEALTH INSURANCE

How long do you need the insurance?

What type of procedure are you going to carry out?

Please let us know when your appointment is at the Spanish Consulate and/or Immigration Offices.

COVERAGE START MONTH is done on the 1st of the month

MONTH END OF COVERAGE Last day of the month

Name and Surname

If you are more insured, please place your date of birth here.

Sex:

Man

Women

Birthdate

Phone number with your country code

Confirm your phone number

Identity document

Passport

Attach Passport/NIE

Upload file

STUDENTS: Attach enrollment form or Letter of Acceptance from the Study Center in the case of students

Upload file

Address of España Completa or of the Study Center so that the card arrives

How much do you weigh and how tall are you approximately?

Have you had any serious illnesses to report in the last 5 years?

Are you currently undergoing any medical treatment? If yes, please indicate the reason, the treatment, and the dosage.

Leave us any questions here; if there is more than one insured person, please write their birth dates here.

Voluntary inclusion

By checking this box, I agree to share my form responses. I agree to be contacted for informational purposes. I accept the privacy policy.