The purpose of this form is to assist you in arranging an online consultation if you cannot attend a consultation in person. To arrange a consultation in person, please use the Make a Consultation Appointment form by clicking here.
If you are arranging an online consultation, please fill in the contact form, describe your medical issue in detail and include front and side view photos of the relevant body part(s). We will use this information to assess a possible solution, and then we will contact you by e-mail.
You can use any of the following languages for consultations: Czech, English, German, Polish, Russian. Consultations in other languages are possible with an interpreter.