STEP 1 OF 3 · Before the form

Before you fill in the form

The form helps Dr Vlad review your situation individually and in depth before we meet.

It is a detailed questionnaire designed for a thorough and personalised assessment. It takes about 15–20 minutes to complete. We recommend filling it out in a quiet environment free from distractions. After submitting, you can also attach your medical records and test results.

Confidentiality

Your medical information and documents are reviewed personally by Dr Vlad. An assistant may only receive contact and organisational details needed for further communication, and has no access to the medical part of your request.

Google services may be used to run the form and store the material you provide. You can read more about data processing, storage and your rights in the Privacy Policy.

Important

The form is intended for planned requests only. Completing it does not guarantee that a consultation will take place.

An online consultation does not replace an in-person appointment or follow-up with your treating doctor and is not intended for making an official diagnosis, or prescribing, stopping or changing treatment. Hypnotherapy is not performed during the first consultation.

If you have severe or worsening chest pain, marked breathlessness, loss of consciousness, sudden weakness, speech difficulty or any other rapid deterioration, do not fill in this form — contact your local emergency medical service.

Data processing

By continuing, you confirm that you have read the data processing terms and agree to the processing of information necessary to review your request.

Required confirmations

All three confirmations are required and must be ticked by you.

I have read the Privacy Policy and the information about the purposes, manner, retention periods and conditions of processing of my personal data.Privacy Policy

I voluntarily consent to the processing of the personal data I provide, including information about my physical and emotional health, for the purpose of pre-assessing my request and arranging a possible consultation.Read the full consent text

I confirm that I am 18 or older, understand the limits of the online format, and realize that an online consultation does not replace the necessary in-person medical follow-up and treatment.

The button becomes active after all three confirmations.

I already have a code

If you have already received a reference code, enter it to return to the questionnaire.