Anna B. Eliseenkova

Feedback form for patients

Данная форма не предназначена для записи на консультацию, не предназначена для заочной консультации.

APPOINTMENTS for consultation are carried out BY PHONE ONLY:

+7 (800) 775-05-82 and +7 (495) 612-45-51 (Mon—Fri: from 8:00 to 20:00)

Заочная консультация не осуществляется. Консультация пациентов производится только очно при личном посещении пациента. Медицинское заключение выдается только на основании очной консультации.

Full name*

Contact phone number*

Subject*

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Feedback form for donors

Full name*

Contact phone number*

Subject*

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Feedback form to the admissions committee

Full name*

Contact phone number*

Subject*

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Feedback form to the director

Full name*

Contact phone number*

Subject*

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Report corruption

Full name*

Contact phone number*

Subject*

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Message the press office

Full name*

Contact phone number*

Subject*

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Contact web support

Форма предназначена для комментариев о функционировании официального сайта НМИЦ гематологии

Full name*

Contact phone number*

Subject*

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Review

Full name*

Contact phone number*

How your name will be displayed in the review tab of the website*

Your E-mail*

Подтвердите Ваш email*

Review text*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Request for medical documents

This form is intended only for sending an application for the issuance of medical reports, certificates, extracts and other medical documents for patients who have passed an in-person medical examination.

Correspondence consultations are not carried out. A medical report is issued only on the basis of a face-to-face consultation.

Without an attached application, passport and a document confirming the status of a legal representative, the feedback form cannot be sent.

Learn more about the procedure for issuing medical documents and their copies

Download the application form

Full name*

Contact phone number*

Subject

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB) (the feedback form cannot be sent without attached documents)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Application*

Passport*

Document confirming the status of the legal representative

FEEDBACK FORM FOR PATIENTS

Full name*

Contact phone*

Citizenship*

Your E-mail*

Country, city

Подтвердите Ваш email*

Message*

Attach files- copies of medical records
(each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Запрос медицинских документов - Тест

This form is intended only for sending an application for the issuance of medical reports, certificates, extracts and other medical documents for patients who have passed an in-person medical examination.

Correspondence consultations are not carried out. A medical report is issued only on the basis of a face-to-face consultation.

Without an attached application, passport and a document confirming the status of a legal representative, the feedback form cannot be sent.

Learn more about the procedure for issuing medical documents and their copies

Download the application form

Full name*

Contact phone number*

Subject

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB) (the feedback form cannot be sent without attached documents)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Application*

Passport*

Document confirming the status of the legal representative

Тестовая форма

Full name*

Contact phone number*

Subject*

Your E-mail*

Подтвердите Ваш email*

Message*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Тестовая форма - Отзыв

Full name*

Contact phone number*

How your name will be displayed in the review tab of the website*

Your E-mail*

Подтвердите Ваш email*

Review text*

Attach files (each attachment not exceeding 4 MB)

You can attach additional documents or materials in electronic format to help better describe the nature of your appeal. The size of the attachment file cannot exceed 4 MB. The following file formats are allowed for attachments: txt, doc, rtf, xls, pps, ppt, pdf, jpg, bmp, png, tiff, gif, pcx, mp3, wma, avi, mp4, wmv, mov, flv.

Anna B. Eliseenkova

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