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Request form

Please, fill in all the fields - this way you will receive the most precise answer.

*(obligatory fields)

Name, Surname of the patient*

Name, Surname (as in the international passport)


Date of Birth

Postcode, City

Address *

ЕMail *

Phone *

The contact person

Disease *

Brief history of condition

Diagnostics

Treatment

Desired duration of stay

Patient room

Professor`s service

Features of service

How did you find out about us?

Upload medical extracts
(max. size of one file 8 MB)



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Do you need help?

Do you need help?

Are you in need of effective rehabilitation? We will help you find the best clinic specializing in your condition. Fill in the form and our specialist will contact you!

Thank you

We received you request for treatment in the best European clinics. Our manager will contact you in the course of the next 24 hours.