Medical Second Opinion Request

Share a few details about your condition to request a medical second opinion.

Our team will contact you shortly to review your case.

The timing of the medical second opinion may vary depending on the country and specialist.

Personal Information

First Name

Last Name

E-mail address

Phone Number

Date of Birth

Year

Month

Day

What medical condition or treatment are you seeking a second opinion for?

Have you received a diagnosis?

Yes

No

Other

If yes, please briefly describe the diagnosis (if known)

Do you have any medical reports, imaging, or test results?

Yes, I will upload

Yes, I will send later

No, not yet

Upload medical documents (optional)

MRI, CT, X-ray, pathology reports, or doctor’s notes (PDF, JPG, PNG)

How soon are you looking to proceed with treatment?

Immediately

Within 1–3 months

3–6 months

Just exploring options

Please share any specific questions or concerns you would like our medical team to review

e.g., treatment options, risks, recovery time, or alternatives

I consent to the use of my information to review my case and contact me regarding my request, as outlined in the Privacy Policy.

I understand that this request does not replace medical advice and agree to the Terms of Use.