Patient questionnaire

Online registration allows you to save up to 20 minutes on your first visit to the clinic.

We value your time!

Clinic:

Patient:

Gender:

Identity documents:

Document type

Contact phone number and email address mail

Registration address:

City, district, subject of the Russian Federation

I am the legal representative/guardian of the patient

Don't forget to bring your identification document with you

Don't forget to bring your identification document with you