Scheduling a CT scan at M24

Dear patient!

To make an appointment for a CT scan, we suggest you fill out the form.

Please answer the questions carefully. If you do not know the answer to the question while completing, you can provide it during a conversation later while speaking with an M24 employee.

Please: keep in mind that the "Back" button at the bottom of the questionnaire window returns you to the previous section of the form, however, the "Back" button in the browser will cause you to leave the form.

By providing your personal data in the questionnaire, you consent to it’s processing and use for the purpose of maintaining a personal data database and organizing the provision of medical services and/or medical care.

* Required field

Email address *

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Last name *

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Name *

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Middle name *

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Date of birth *

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Height, cm *

Height must be more than 70cm and less than 250cm

Weight, kg *

Weight must be more than 15 kg and less than 150 kg

Patient's phone number (appointment-related service messages will be sent to this phone number) *

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Sex * male female

You must choose one option

Are you pregnant at the time of the study?* no yes

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Pregnancy term *

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Referring doctor’s full name

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Previous diagnosis (specified in the doctor's referral) or complaints (in the absence of a diagnosis)

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Do you (the patient) walk independently, without assistance? * Yes I move around with the help of crutches / a walker / a wheelchair I can't sit or walk on my own

You must choose one option

Which examination do you need? * I will copy from a doctor's referral I will choose from the list provided

You must choose one option

Name of the study indicated in the doctor's referral

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Please indicate any additional wishes regarding your appointment

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Completing the СТ exam registration form

I consent to the processing of personal data

I confirm that I have read and accept the terms of services the Public Contract (Offer) for the provision of medical services