Request for rehabilitation

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Your contact information has been received. Our specialists will contact you in within two working days!

If you would like to reduce the time of processing your request, please fill in the form below in English. Your answers to these questions will help our professionals to better assess the health status of the patient.**

**The language of the questionnaire is in the masculine form for brevity, however the questions relate equally to both males and females.

Personal data
Accompanying person
Strongly recommended that the accompanying person will be the same individual who will continue to take care of the patient at home.
Information about the disease and the patient's condition
General condition of the patient on the day of filling in the questionnaire
Please scan and upload the latest medical findings, as well as the results of tests and examinations, from the last six months.
Please also bring ALL OTHER DOCUMENTS AND IMAGING RESULTS (CT / MRI/ PET /US) with you to our clinic. Please upload your files (maximum file size: 2 MB): Permitted file types: pdf, gif, jpg, png, bmp, txt, rtf, doc, docx, xls, xlsx.
Максимальный размер файла: 2 МБ.
Разрешённые типы файлов: gif jpg jpeg png bmp txt rtf pdf doc docx xls xlsx.

Apply for rehabilitation in Reuth Medical Rehabilitation Center