Remote consult form

Remote consult

If you need a remote consult of a neurosurgeon, you may:

● Send all the doctor’s notes, patient’s complaints and images (CD / film) in a registered letter (parcel) by Mail to the following address: 625032, Russian Federation, Tyumen, PO Box 2138 "Federal Center of Neurosurgery". After the consult, all the documents, images and medical conclusion of a neurosurgeon will be sent back to you by Mail.

● If you want to receive the consult of a neurosurgeon by means of this website, you need to complete the following form:

NOTE!

We inform you that this form is designed for patients who have any neurosurgical pathology, diagnostically confirmed (detected after x-ray, ultrasound, or tomography).

In case you only suspect the presence of a disease, you need to contact the clinic at your place of residence to undergo the necessary examinations in order to obtain objective data on the state of your health (it is possible that the identified deviations can be resolved by therapeutic means without surgery. If there is a need after the follow-up examinations, you can fill in this form to receive a remote consult).

To make the interaction more effective, we would ask you to answer a number of questions that will help our doctors to get a more vivid picture of the patient’s health status.

We are obliged to warn you that this data channel is not a secure connection and by agreeing to data transfer, you are aware of the likely risks. Access to the data, transmitted by you, will be only available to employees of our institution whose job duties comprise remote reviewing and consulting patients according to the documents they have sent us.

Please, fill in the form

* mandatory fields

I am aware of the risks and consciously make the decision to send personal data

Please send a response to this email address: *

You may refer to me as (full name): *

I am applying for: *

Telephone number to get in touch: *

Patient’s full name: *

Is the patient an employee of the internal affairs division of a law enforcement agency of the Russian Federation, to whom medical care is provided in accordance with the Order of the Government of the Russian Federation No. 1563 of 12/15/2018: *

What is the purpose of your application? *

Patient’s sex: *

Patient’s age: *

Nationality: *

Country of residence: *

Region (oblast, krai) only for Russian residents: *

What examination revealed the disease: *

When was this examination performed (month, year): *

Complaints: *

NOTE!

If you send us additional examination results, it will help out doctors to assess all the all the features of the disease and choose the most effective treatment.

In this field, you need to attach: medical repots and other medical conclusions, images in DICOM format (MRI or CT in archive)

file extensions: RAR, ZIP, JPG, GIF, PNG, BMP, TIFF, DOC, DOCX, XLS, XLSX, TXT, PDF, ODT, ODS, DJVU (700 MB limit)

ATTACH: *

Upload

If your images are on CD.

1. Open the CD – find a directory called DICOM or Image or A or Data.

2. Put the data into an archive using winRAR or just load the data to file sharing service

If you have film images.

1. Take a photograph of the images on a digital camera. DO NOT SCAN! It is better to take photographs against a white monitor screen (open a blank page in Paint or Word) or against a bright window, then attached the file and load it.

Note: do not take a photograph of the entire film, you need to picture each part of it.