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Booking for outpatient appointments or diagnostic services

Please complete all fields. Within 2 working days of receipt of your form, one of our operators will contact you for an appointment.

Reserving an appointment for:

Scheme under which service will be delivered

Choose from:

Le nostre sedi:

Applicant's personal data

Contact information


Attach request

To speed up the booking procedure, you may attach your doctor's request to this form by following these instructions:

  • scan the request and save the scanned copy in your computer as an image (jpeg)
  • use the function here below 'attach doctor's request' to select the file and attach it to the form.
Select file

Accept the terms - Within the meaning of Decree-law no. 196/2003, I hereby confirm that I have read the information set out above and agree to my personal data being used for the purposes and within the limitations defined therein. Within the meaning of Decree-law no. 196/2003, I hereby confirm that I have read the information set out above and agree to my personal data being used for the purposes and within the limitations defined therein.

 

By autson.com