PATIENT'S CONSENT TO RECEIVE SERVICES (ONLY FOR SELF-REFERRAL PATIENTS)

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0 800 752 180

Консультация врача

0 800 219 696

Ежедневно с 07:00 до 20:00

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For DILA customers who have got negative result of their COVID-19 PCR test or Rapid Аntigen Тest

Dear customer!
To terminate your self-isolation through VDOMA App, please fill-in this form:

First name

Last name

Date of birth

Оrder code

Contact telephone

DILA automatically reports negative results to CPH for further removal from the "Vdoma" application. Please indicate the phone number, which application «Vdoma» is linked (the number you provided during registration in «Vdoma»).

Date of return

Sample collection date