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Cleansing of blood

Preliminary record
on consultation
in Center of Extracorporal hemocorrection
On this page you can place an order on advisory reception in our Center.
Fill in the form located below (fields marked by asterisks - are obligatory to filling) and press button "Send".
Necessarily specify contact E-mail and, extremely to a measure, one contact phone for connection with you.
Right after sendings of the application you receive on yours E-mail message - acknowledgement on reception of your application by us. In the near future after sending the application - we shall contact you by phone and we shall coordinate date convenient for you and time of consultation.
Attentively fill in the form
Name and last name : *
Yours Email : *
You live in Moscow : *
Your age : *
Contact phone 1 : *
Contact phone 2 : *
Complaints : *
The basic diagnosis :
The additional information :
Desirable date and time of consultation : *
 

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115409, Russia, Moscow, Moskvorechje str., 16a;


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