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Medical appointment application

Page updated 21/05/2024 18:50

Medical appointment application

Medical appointment application

Contract number*

Contract number*

Name*

Name*

Surname*

Surname*

Phone number*

Phone number*

Date of birth*

Date of birth*

Date of the Accident

Date of the Accident

Complaints/Description*

Complaints/Description*

What services do you need?*

What services do you need?*

Indicate if you need a call back from our expert doctor

When to call you back?

When to call you back?

Ներբեռնի՛ր ԼԻԳԱ հավելվածը և ստացիր զեղչի պրոմոկոդեր բոլոր ապահովագրության տեսակների համար։

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