Radiology voucher

Download and fill out our radiology voucher
Transfer your completed and signed voucher *
Drop files here or

Accepted file types: jpg, jpeg, pdf.
You can send us a photo of your radiology voucher or scan it and drag it below.
Remarks
Coordonnées du patient
Nom du patient*
N° de téléphone (mobile)*
Email du patient (pour copie de bon)
Conditions*
- I confirm that I have read the terms of the electronic communication and privacy policy and agree to receive medical information by e-mail which may be unencrypted.
  
  I understand that I can withdraw my consent at any time to receive medical information by contacting my healthcare provider or via info@magellan.ch.
Name
This field is for validation purposes and should be left unchanged.

Coordonnées du patient