Your Name and Surname (required)
Your Email (required)
Current Diagnosis and Comorbidities (required)
This Diagnosis is the reasion why you seek a Second Opinion. Please, provide us also with detailed information on comorbidities, i.e. Diabetes Mellitus; Coronary Artery Disease; Atrial Fibrillation etc.
Current Complaints and General Condition of the Patient (required)
Please, please provide us with detailed natural history of the disease and the current general condition of the Patient. Our local doctors need to estimate the physical status of the patient according to ASA-Classification.
Existing diagnostic measures: X-Ray; CT; MRT; Sonography; Endoscopy; Laboratory tests; EKG; Diagnostic laparoscopy etc. Please note that you will get a secure link (can be used only one time) to upload your data. If you make a new Radiology Investigation please give your name as it appears on your passport to avoid mistakes in follow-up.
Previous treatments and current medication (required)
What kind of treatments (medical or/and surgical) did you receive and how were the effects. Please provide us with detailed information on the medications (Dosage, Duration, Response) and surgeries (if possible Surgery-Report) performed.
What are your expectations?
Do you want only Second Opinion? Do you plan to get treatment abroad?