Make an appointment - gastroenterology

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Doctors

Name

First name

Birthdate

Gender

Man

Woman

I prefer not to specify

Phone

Address

Postal code

Identification number of the National Register

Reason for request

Prescription from your general practitioner

Please enclose your doctor's prescription if you would like an appointment for a colonoscopy or oeso-gastro-duodenoscopy (OGD).
One file only.
64 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.