CENTER OF ANTHROPOMETRIC
(ORTHOPEDIC) COSMETOLOGY AND CORRECTION

+7 8442 502185
Call us
eng | it | sp | de | fr | bg | cz

Height increase and legs correction


Patient registration form

To receive more infomation about services and costs or enrol for the consultation or surgery we recommend you to fill in the patient register form.


 
Your Name*
Birthday Select date in calendar (MM/DD/YYYY)
E-mail*
Street address
City
State/region
ZIP/post index
Country
Telephone
You interest
If you plan to arrive to the Centre, please write in an approximate time of your visit. Select date in calendar (MM/DD/YYYY)
How have you known about this site
Please specify
Questions that instersting for you
Protection from automated form filling
 
Please type in the symbols shown in the image above*
 

* - required fields