ONLINE CONSULTATION

Instructions

Alai Sport Medicine Clinic has an online service for those who can not move to the clinic or require urgent treatment at a distance.

To access this mode, you must follow three simple steps:

Fill out the inquiry form with as much information and as accurately as possible.
Attach all available tests (X-rays, magnetic resonance, TAC ..) in chronological order by attaching them through the following page in the Wetransfer Plus box.
Go to the next page and pay for the consultation through PayPal.

Once the consultation has been paid via PayPal, we will get in touch with you as soon as possible.

You will be contacted by telephone or by videoconference to complete the consultation.

If you want some more information, you can write to info@alaismc.com.

To access the online consultation is essential to fill out this form.

First & Last Name *

Email *

Subject

PHONE:*
Select your country code:*

Your phone number:*

SPORTS:

BIRTHDATE (ATTENTION: in Safari date format must be: yyyy-mm-dd):

REASON FOR CONSULTATION:

PERSONAL MEDICAL HISTORY:
1. Do you have any allergies?

2. Surgeries and previous dates?

3. Other diseases?

4. Any regular medication?

HISTORY:
5. When did the symptoms begin?

6. How it began? Trauma?

7. What is the pain level from 1 to 10? 8. What are the main symptoms?

9. What treatments did you complete?

TO BE COMPLETED BY THE DOCTOR: 10. Physical exam:

11. Complementary tests:

12. Diagnosis:

13. Treatment:

OTHERS COMMENTS

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