TELEMEDICINE – BOOKING

TELEMEDICINE – REQUEST FORM

Title *

Name *

Surname *

Email Address *

You’ll receive the videocall link to this email address.

Confirm Email Address *

Phone number

Home Address *

A home address is required for invoicing. Please give street name, town, ZIP code, and country of residence.

Clinical information *

Date

Time

Discount Code

If you have any discount code, please type it in this field (all capital letters).

Privacy *

In accordance with European GDPR (Regulation on data privacy protection), I hereby declare to have read the privacy protection protocol and I authorize you to process my personal data for the purposes of this counseling service.

By clicking Submit below you’ll be redirected to the payment page (PayPal). Once the payment is completed, you will receive a confirmation email containing the Skype connection details.

Feel free to call us to book your appointment

CONTACT FORM

NAME *

SURNAME *

COUNTRY

EMAIL ADDRESS *

Enter Email

Confirm EMAIL ADDRESS *

Confirm Email

TELEPHONE

SUBJECT *

YOUR MESSAGE *

I want to receive the newsletter

I consent to the processing of my data and I declare that I have read the Privacy Policy

reCAPTCHA

DIAGNOSTICS

HIGH THROUGHPUT

ANCILLARY

CLASSICS

PROACTIVE

PREDICTIVE TESTING

EXOME PRO / GENOME PRO

TELEMEDICINE – BOOKING

Tests

Others

Registered office and Business

Main office & Laboratory

Feel free to call us to book your appointment

CONTACT FORM

Subscribe to our newsletter to receive news on the world of genetics.

DIAGNOSTICS

HIGH THROUGHPUT

ANCILLARY

CLASSICS

PROACTIVE

PREDICTIVE TESTING

EXOME PRO / GENOME PRO

TELEMEDICINE – BOOKING

Tests

Others

Registered office and Business

Main office & Laboratory

Feel free to call us to book your appointment

CONTACT FORM

Subscribe to our newsletter to receive news on the world of genetics.

Newsletter Signup