\n' + ' \n' + ' \n' + '

{{ general_error }}

Application for remote consultation at “{{ clinic.name }}”

Choose a service...

{{ service.name }} ({{ service.default_duration_days }} days)

{{ service.description }}

Service cost: {{ service.price }} ₽
Coaches: {{ doctor.name }} ({{ doctor.specialty }}),
The application is confirmed by a medical institution

Choose a specific coach

If you want to sign up for a specific specialist

Choose a coach...

{{ doctor.name }} ({{ doctor.specialty }})

Duration of consultation: {{ doctor.minimum_days }} days {{ doctor.minimum_days }}-{{ doctor.maximum_days }} days
Cost per day: {{ doctor.price }} ₽
The application is confirmed by a medical institution
Back

You have chosen the {{ request.service.name }}. Doctor - {{ request.doctor.name }}.

You have selected coach {{ request.doctor.name }} ({{ request.doctor.specialty }}).

Enter your email

{{ errors.email }} It is important to indicate a valid email, we will send a confirmation code and a link to activate the consultation to it.
Back Next

Confirm your email

We have sent a confirmation code to your email. Please check your inbox (and Spam folder) and enter the code below.

{{ errors.email_verification }} We have sent a confirmation code to your email.
Email confirmed
Back Next

You have chosen the {{ request.service.name }}.

You have selected a coach {{ request.doctor.name }} ({{ request.doctor.specialty }}).

{{ user_info.account.name }}
We found a Medsenger account associated with this email. If this is not you, go back and enter another email.

Provide information about yourself...

{{ errors.name }} Last name First name Patronymic, as in the passport
{{ errors.password }}
{{ errors.password_confirmation }}
{{ errors.passport }} In accordance with the law, a passport number is required for one-time confirmation of identity through the unified identification and authentication system. We do not store the passport number in our database.
{{ errors.birthday }} format dd.mm.yyyy
{{ errors.consent_agree }}

Purpose of consultation

An employee of the medical organization will agree with you over the phone after submitting your application.
{{ errors.phone }} An employee of a medical organization can contact you at this number to clarify organizational issues.
{{ errors.description }}
File attached {{ request.attachments[i].name }}   Delete? {{ errors.attachments[i] }}
You can attach any number of medical documents to your application. Certificates, test results, extracts - the more information you provide to the coach, the easier it will be to provide you with qualified assistance.
Back
Back

Legal issues...

Please read the following documents carefully. Some of them may need to be photographed (scanned) and attached to the application.

File selected {{ request.documents[document.id].name }} {{ errors.documents[document.id] }} {{ document.description }} You need to download the template, fill it out and attach a copy (scan/photo) of the document to the application. You need to attach a copy (scan/photo) of this document to your application.
{{ errors.documents[document.id] }} {{ document.description }} Please check the box to confirm that you have read and agree to the document.
BackNext

Almost done...

Carefully check that all data is entered correctly and click the "send a request" button.

Service
{{ request.service.name }} Change?
Coach
{{ request.doctor.name }} ({{ request.doctor.specialty }}) Change?
Desired duration of consultation
{{ readable_days }} Change?
Your email
{{ request.email }} Change?
Your phone number
+7{{ request.phone }} Change?

Submit your application...

\n' + ' \n' + ' \n' + '

Application sent!

Your application number - {{ request_id }}.

Consultation is open.

Go to Medsenger Sign in

If you have questions or want to change anything on your application, you can contact {{ clinic.name }} at {{ clinic.phone }}.

Thank you for using the service!

Something went wrong...

During the sending of the application, an error occurred. try again or change the application ?

{{ request_error }}