Skip to main content
Toggle navigation
Contact
Who we are
Services
93 227 93 91
Access medical report
ENGLISH
CATALÀ
ESPAÑOL
Twitter
Linkedin
Home
Contract
FAQs
Sign up
Find out more
1
Sign up data
2
Payment
3
Report
Sign up
Language
Language neutral
Catalan
English
Spanish
Consultation
Speciality *
Speciality
*
- Select a value -
Autoimmune Diseases
Cardiology
Maternal-Fetal Medicine
Urology and Uro-oncology
Background *
Background
*
Tests performed *
Tests performed
*
Disease explanation *
Disease explanation
*
Specific questions *
Specific questions
*
Documents
Add a new file
Upload
More information
Files must be less than
300 MB
.
Allowed file types:
txt doc docx pdf jpeg jpg png gif dcm zip
.
The data of the person making the request and the patient data are the same.
Patient data
Document patient *
Type
- None -
DNI
NIE
Passport
Others
Document
Sex patient *
Sex patient
*
Male
Female
Patient name *
Patient name
*
First surname patient *
First surname patient
*
Second surname patient
Second surname patient
Birthday patient *
*
*
Day
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
*
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
*
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
Telephone patient *
Telephone patient
*
Country patient *
Country patient
*
- Select a value -
Afghanistan
Albania
Germany
Andorra
Angola
Anguilla
Antarctica
Antigua/Barbuda
Dutch Antilles
Saudi Arabia
Algeria
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belgium
Belize
Benin
Bermuda
White Russia
Bolivia
Bosnia-Herz.
Botswana
Brazil
Brunei Dar-es-S
Bulgaria
Burkina-Faso
Burundi
Bhutan
Cape Verdian
Cayman Islands
Cameroon
Canada
Chad
Chile
China
Cyprus
Vatican City
Columbia
Comorin
Congo
Cook Islands
North Korea
South Korea
Ivory Coast
Costa Rica
Croatia
Cuba
Denmark
Dominica
Unit.Arab Emir.
Ecuador
USA
Egypt
El Salvador
Eritrea
Slovenia
Spain
Estonia
Ethiopia
Faroe Islands
Russian Fed.
Philippines
Finland
Fiji
France
Gabon
Gambia
Georgia
Ghana
Gibraltar
Great Britain
Grenada
Greece
Greenland
Guadeloupe
Guam
Guatemala
Guyana
Guinea
Equatorial Gui.
French Guinea
Guinea-Bissau
Haiti
Heard/McDon.Isl
Netherlands
Honduras
Hong Kong
Hungary
India
Indonesia
Iran
Iraq
Ireland
Amer.Virgin Is.
Maldives
Minor Outl.Ins.
Seychelles
Brit.Virgin Is.
N.Mariana Islnd
Iceland
Bouvet Island
Cocos Islands
Falkland Islnds
Marshall Islnds
Christmas Islnd
Niue Islands
Norfolk Island
Pitcairn Islnds
Tokelau Islands
Israel
Italy
Jamaica
Japan
Jordan
Cambodia
Kasachstan
Kenya
Kirghistan
Kiribati
Kuwait
Laos
Lesotho
Latvia
Lebanon
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malaysia
Malawi
Mali
Malta
Morocco
Martinique
Mauritius
Mauretania
Mayotte
Mexico
Micronesia
Moldavia
Monaco
Mongolia
Montserrat
Mozambique
Myanmar
Namibia
Nauru
Nepal
Nicaragua
Nigeria
Nigeria
Norway
New Caledonia
New Zealand
Oman
Pakistan
Palau
Panama
Papua Nw Guinea
Paraguay
Peru
Frenc.Polynesia
Poland
Portugal
Puerto Rico
Qatar
Centr.Afr.Rep.
Czechoslovakia
Dominican Rep.
Slovakia
Reunion
Ruanda
Romania
S.Tome,Principe
Solomon Islands
Samoa,American
Western Samoa
San Marino
St. Vincent
St. Helena
St. Lucia
Senegal
Yugoslavia
Sierra Leone
stateless
Singapore
Syria
Somalia
Sri Lanka
St.Chr.,Nevis
St.Pier,Miquel.
Swaziland
South Africa
Sudan
Sweden
Switzerland
Suriname
Svalbard
Thailand
Taiwan
Tanzania
Tadzhikistan
Brit.Ind.Oc.Ter
East Timor
Togo
Tonga
Trinidad,Tobago
Tunisia
Turkmenistan
Turksh Caicosin
Turkey
Tuvalu
Ukraine
Uganda
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Wallis,Futuna
Yemen
Djibouti
Yugoslavia
Zaire
Zambia
Zimbabwe
Province patient *
- Select -
Alacant
Alava
Albacete
Almería
Asturias
Avila
Badajoz
Balears
Barcelona
Burgos
Cáceres
Cádiz
Cantabria
Castelló
Ceuta
Ciudad Real
Córdoba
Cuenca
Girona
Granada
Guadalajara
Guipúzcoa
Huelva
Huesca
Jaén
La Coruña
La Rioja
Las Palmas
León
Lleida
Lugo
Madrid
Málaga
Melilla
Murcia
Navarra
Orense
Palencia
Pontevedra
Salamanca
Segovia
Sevilla
Soria
Sta. Cruz Tenerife
Tarragona
Teruel
Toledo
València
Valladolid
Vizcaya
Zamora
Zaragoza
Others
Patient address *
Patient address
*
Patient city *
Patient city
*
Postcode patient
Postcode patient
Email patient *
Email patient
*
Repeat email patient *
Repeat email patient
I have notified consent of the patient to consult on its behalf and provide the required information *
Applicant data
Document applicant *
Type
- None -
DNI
NIE
Passport
Others
Document
Sex applicant *
Sex applicant
N/A
Male
Female
Applicant name *
Applicant name
First surname applicant *
First surname applicant
Second surname applicant
Second surname applicant
Birthday applicant *
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
Telephone applicant *
Telephone applicant
Applicant country *
Applicant country
- None -
Afghanistan
Albania
Germany
Andorra
Angola
Anguilla
Antarctica
Antigua/Barbuda
Dutch Antilles
Saudi Arabia
Algeria
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belgium
Belize
Benin
Bermuda
White Russia
Bolivia
Bosnia-Herz.
Botswana
Brazil
Brunei Dar-es-S
Bulgaria
Burkina-Faso
Burundi
Bhutan
Cape Verdian
Cayman Islands
Cameroon
Canada
Chad
Chile
China
Cyprus
Vatican City
Columbia
Comorin
Congo
Cook Islands
North Korea
South Korea
Ivory Coast
Costa Rica
Croatia
Cuba
Denmark
Dominica
Unit.Arab Emir.
Ecuador
USA
Egypt
El Salvador
Eritrea
Slovenia
Spain
Estonia
Ethiopia
Faroe Islands
Russian Fed.
Philippines
Finland
Fiji
France
Gabon
Gambia
Georgia
Ghana
Gibraltar
Great Britain
Grenada
Greece
Greenland
Guadeloupe
Guam
Guatemala
Guyana
Guinea
Equatorial Gui.
French Guinea
Guinea-Bissau
Haiti
Heard/McDon.Isl
Netherlands
Honduras
Hong Kong
Hungary
India
Indonesia
Iran
Iraq
Ireland
Amer.Virgin Is.
Maldives
Minor Outl.Ins.
Seychelles
Brit.Virgin Is.
N.Mariana Islnd
Iceland
Bouvet Island
Cocos Islands
Falkland Islnds
Marshall Islnds
Christmas Islnd
Niue Islands
Norfolk Island
Pitcairn Islnds
Tokelau Islands
Israel
Italy
Jamaica
Japan
Jordan
Cambodia
Kasachstan
Kenya
Kirghistan
Kiribati
Kuwait
Laos
Lesotho
Latvia
Lebanon
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malaysia
Malawi
Mali
Malta
Morocco
Martinique
Mauritius
Mauretania
Mayotte
Mexico
Micronesia
Moldavia
Monaco
Mongolia
Montserrat
Mozambique
Myanmar
Namibia
Nauru
Nepal
Nicaragua
Nigeria
Nigeria
Norway
New Caledonia
New Zealand
Oman
Pakistan
Palau
Panama
Papua Nw Guinea
Paraguay
Peru
Frenc.Polynesia
Poland
Portugal
Puerto Rico
Qatar
Centr.Afr.Rep.
Czechoslovakia
Dominican Rep.
Slovakia
Reunion
Ruanda
Romania
S.Tome,Principe
Solomon Islands
Samoa,American
Western Samoa
San Marino
St. Vincent
St. Helena
St. Lucia
Senegal
Yugoslavia
Sierra Leone
stateless
Singapore
Syria
Somalia
Sri Lanka
St.Chr.,Nevis
St.Pier,Miquel.
Swaziland
South Africa
Sudan
Sweden
Switzerland
Suriname
Svalbard
Thailand
Taiwan
Tanzania
Tadzhikistan
Brit.Ind.Oc.Ter
East Timor
Togo
Tonga
Trinidad,Tobago
Tunisia
Turkmenistan
Turksh Caicosin
Turkey
Tuvalu
Ukraine
Uganda
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Wallis,Futuna
Yemen
Djibouti
Yugoslavia
Zaire
Zambia
Zimbabwe
Province applicant *
- Select -
Alacant
Alava
Albacete
Almería
Asturias
Avila
Badajoz
Balears
Barcelona
Burgos
Cáceres
Cádiz
Cantabria
Castelló
Ceuta
Ciudad Real
Córdoba
Cuenca
Girona
Granada
Guadalajara
Guipúzcoa
Huelva
Huesca
Jaén
La Coruña
La Rioja
Las Palmas
León
Lleida
Lugo
Madrid
Málaga
Melilla
Murcia
Navarra
Orense
Palencia
Pontevedra
Salamanca
Segovia
Sevilla
Soria
Sta. Cruz Tenerife
Tarragona
Teruel
Toledo
València
Valladolid
Vizcaya
Zamora
Zaragoza
Others
Applicant address *
Applicant address
Applicant city *
Applicant city
Applicant postcode *
Applicant postcode
Email applicant *
Email applicant
Repeat email applicant *
Repeat email applicant
I accept the
privacy policy
*
* Required fields
Title
*
Vertical Tabs
Next step