Ishchanova Raushan Asylkhanovna

Description

Doctor

First Name [text* your-name-first autocomplete:name class:form-control placeholder “Please enter your first name”]

Middle name (Optional) [text your-name-mid autocomplete:name class:form-control placeholder “Please enter your middle name”]

Last Name [text* your-name-last autocomplete:name class:form-control placeholder “Please enter your last name”]

Sex

[radio your-sex default:1 “Male” “Female” “Others”]

Date of Birth

[text* your-birth autocomplete:name class:form-control class:input-date class:input-dtr class:format-date class:single-picker class:maxdate-moment placeholder “MM/DD/YYYY”]

IIN [text* your-iin autocomplete:name class:form-control placeholder “Please enter an IIN.”]

*If you are an alien, please enter your passport number.

City of Residence [text* your-city autocomplete:name class:form-control placeholder “Please enter your city.”]

Nation [text* your-country class:form-control placeholder “Please enter your nation”]

Desired Date [text* your-reservation class:form-control class:input-date class:input-dtr class:format-datetime class:single-picker class:mindate-moment placeholder “DD/MM/YYYY 00:00 AM/PM”]

Email [email* your-email autocomplete:email class:form-control placeholder “Please enter your email address.”]

Mobile Phone number [tel* your-tel autocomplete:tel class:form-control class:w-100 placeholder “+7( )- – -“]

Parent’s(guardian’s) Phone number [tel your-tel-other-1 autocomplete:tel class:form-control class:w-100 placeholder “+7( )- – -“]

Treatment method

Outpatient clinic

Symptoms / Questions [textarea your-message class:form-control 30×10 placeholder “※ Please enter the details of what you want to consult.”]

Attachments

[text your-file-output readonly class:form-control class:file-input class:input-text placeholder “Please attach a file related to the consultation (maximum 10MB or less)”] [file your-file class:file-hidden limit:2mb filetypes:image/*|txt|application/pdf|mp4|avi|zip|egg id:your-file id:your-file class:input class:input-file]

[acceptance privacy-acceptance-confirm class:ohc-check-input]I agree to the Terms of Use and Privacy Policy.[/acceptance] [acceptance age-confirm class:ohc-check-input]I am 14 years old or older[/acceptance]

[submit class:btn class:btn-round class:btn-mid class:btn-primary class:me-1 “Contact us”]

Additional information

Medical Treatment Type	Follow-up consultation, Initial consultation
Appointment Date	01/11/2024, 01/12/2024, 02/11/2024, 02/12/2024, 03/11/2024, 03/12/2024, 04/10/2024, 04/11/2024, 05/10/2024, 05/11/2024, 06/10/2024, 06/11/2024, 07/10/2024, 07/11/2024, 08/10/2024, 08/11/2024, 09/10/2024, 09/11/2024, 10/10/2024, 10/11/2024, 11/10/2024, 11/11/2024, 12/10/2024, 12/11/2024, 13/10/2024, 13/11/2024, 14/10/2024, 14/11/2024, 15/10/2024, 15/11/2024, 16/10/2024, 16/11/2024, 17/10/2024, 17/11/2024, 18/10/2024, 18/11/2024, 19/10/2024, 19/11/2024, 20/10/2024, 20/11/2024, 21/10/2024, 21/11/2024, 22/10/2024, 22/11/2024, 23/10/2024, 23/11/2024, 24/10/2024, 24/11/2024, 25/10/2024, 25/11/2024, 26/10/2024, 26/11/2024, 27/10/2024, 27/11/2024, 28/10/2024, 28/11/2024, 29/10/2024, 29/11/2024, 30/10/2024, 30/11/2024, 31/10/2024
Appointment Time	00:30, 01:00, 01:30, 02:00, 02:30, 03:00, 03:30, 04:00, 04:30, 05:00, 05:30, 06:00, 06:30, 07:00, 07:30, 08:00, 08:30, 09:00, 09:30, 10:00, 10:30, 11:00, 11:30, 12:00, 12:30, 13:00, 13:30, 14:00, 14:30, 15:00, 15:30, 16:00, 16:30, 17:00, 17:30, 18:00, 18:30, 19:00, 19:30, 20:00, 20:30, 21:00, 21:30, 22:00, 22:30, 23:00, 23:30, 00:00