Make an appointment using a paper referral

Please fill in the form

Use this type of entry if you have a paper referral. Fill in your personal data and attach a paper referral consisting of one or two parts.

When you fill out the form, a customer service specialist will get in touch to confirm and finalize your appointment details.

You can check the status of your appointment here: link

Name

Surname

National identification number

Phone

Service Select service from services list or enter service name manualy

The name of the doctor who issued the referral

Please upload one or two files (depending on the referral type).
We support the following formats: png, jpeg, gif, pdf.

Referral file

No files selected

Or drag and drop file to upload.

Additional file

No files selected

Or drag and drop file to upload.

Consent to data processing

Make sure all required fields are filled out correctly and try submitting the form again.