Version for the visually impaired

+7(7172) 70-80-90
+7 702 006 56 56

Remote consultation for the legal entity on a fee-for-service basis

* Company Name
* Patient's Full Name
* Patient's ID Number
* Patient's Date of Birth (MM/DD/YYYY)
Organization's Email Address
* Contact Person's Phone Number
Attach doctor's report, lab and imaging results, and other documents (if available)
Specify the date and time of the online consultation (MM/DD/YYYY)
* Referring Doctor's Full Name
* Referring Doctor's Phone Number
Purpose of Online Consultation

* - Required fields



Hospital Partners