Application for organization of medical care for the insured under voluntary medical insurance

• Processing of applications is carried out only on working days.
• Saturday, Sunday, public holidays and public holidays are days off.
• The application, left at the day off, will be processed on the next working day.
• The application for the organization of medical care, submitted until 12.00 on a working day, is served on the same day.
• If the application is filed on a day off or after 12.00 on a working day, the application is executed on the next working day after the filing day.
• Attention! When applying for medical assistance in the referral of Belgosstrakh to a medical institution, it is necessary to present a passport.

• Last name: *
• First name: *
• Patronymic:
• Birthday: *
  Incorrect date. Enter the date in the format "day.month.year". For example: 20.01.1990.
• Phone number: *
• Email: Incorrect Email.
• Insurance policy series: * Incorrect insurance policy series. The series can only contain digits, or "БР", or "БВ", or format "DDDDDD-DD".
• Insurance policy number: * Incorrect insurance policy number. The number must contain only digits.
• The city where it is necessary to organize a medical service: *
• Type of medical service (medical consultation, research): *
• Desired date and time of medical service: *
• Additional Information: