Зубной доктор
+7 (495) 230-55-93
Пройдите анкету о состоянии здоровья
Это поможет нам сэкономить ваше время и начать прием без дополнительных задержек
Далее
Назад
[{"lid":"1707750106606","ls":"10","loff":"","li_type":"nm","li_name":"name","li_title":"\u0424\u0430\u043c\u0438\u043b\u0438\u044f, \u0418\u043c\u044f \u0438 \u041e\u0442\u0447\u0435\u0441\u0442\u0432\u043e","li_ph":"\u0410\u043d\u0442\u043e\u043d\u043e\u0432 \u0412\u043b\u0430\u0434\u0438\u043c\u0438\u0440 \u0412\u0438\u043a\u0442\u043e\u0440\u043e\u0432\u0438\u0447","li_req":"y","li_nm":"name"},{"lid":"1707751721591","ls":"20","loff":"","li_type":"da","li_name":"date","li_title":"\u0414\u0430\u0442\u0430 \u0440\u043e\u0436\u0434\u0435\u043d\u0438\u044f","li_ph":"21.05.1980","li_req":"y","li_dateformat":"DD-MM-YYYY","li_datediv":"dot","li_nm":"date","li_datemask":"99.99.9999"},{"lid":"1707753360796","ls":"30","loff":"","li_type":"sb","li_name":"priem","li_title":"\u041f\u043e\u0441\u043b\u0435\u0434\u043d\u0435\u0435 \u043f\u043e\u0441\u0435\u0449\u0435\u043d\u0438\u0435 \u0432\u0440\u0430\u0447\u0430 \u0441\u0442\u043e\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0430","li_req":"y","li_variants":"\u0414\u043e 3 \u043c\u0435\u0441\u044f\u0446\u0435\u0432\n\u0414\u043e 6 \u043c\u0435\u0441\u044f\u0446\u0435\u0432\n\u0414\u043e 1 \u0433\u043e\u0434\u0430\n\u0411\u043e\u043b\u0435\u0435 1 \u0433\u043e\u0434\u0430","li_nm":"priem"}]
1/5
Заполняя форму, я даю свое согласие на обработку моих персональных данных, в соответствии с Федеральным законом от 27.07.2006 года №152-ФЗ
[{"lid":"1707750106606","ls":"10","loff":"","li_type":"rd","li_name":"allergy","li_title":"1. \u0410\u043b\u043b\u0435\u0440\u0433\u0438\u0447\u0435\u0441\u043a\u0438\u0435 \u0440\u0435\u0430\u043a\u0446\u0438\u0438 ","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"allergy"},{"lid":"1707753808427","ls":"20","loff":"","li_type":"in","li_name":"allergyYES","li_title":"\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u0430\u043a\u0438\u0435?","li_nm":"allergyYES"},{"lid":"1707753894146","ls":"30","loff":"","li_type":"rd","li_name":"bronchitis","li_title":"2. \u0411\u0440\u043e\u043d\u0445\u0438\u0430\u043b\u044c\u043d\u0430\u044f \u0430\u0441\u0442\u043c\u0430","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"bronchitis"},{"lid":"1707753932944","ls":"40","loff":"","li_type":"rd","li_name":"cardio","li_title":"3. \u0421\u0435\u0440\u0434\u0435\u0447\u043d\u043e-\u0441\u043e\u0441\u0443\u0434\u0438\u0441\u0442\u044b\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"cardio"},{"lid":"1707753945964","ls":"50","loff":"","li_type":"in","li_name":"cardioYES","li_title":"\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u0430\u043a\u0438\u0435?","li_nm":"cardioYES"},{"lid":"1707753997729","ls":"60","loff":"","li_type":"rd","li_name":"cardiostimulator","li_title":"4. \u041d\u0430\u043b\u0438\u0447\u0438\u0435 \u043a\u0430\u0440\u0434\u0438\u043e\u0441\u0442\u0438\u043c\u0443\u043b\u044f\u0442\u043e\u0440\u0430","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"cardiostimulator"},{"lid":"1707754034726","ls":"70","loff":"","li_type":"rd","li_name":"Diabetes","li_title":"5. \u0421\u0430\u0445\u0430\u0440\u043d\u044b\u0438\u0306 \u0434\u0438\u0430\u0431\u0435\u0442","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Diabetes"}]
Далее
2/5
По каждому пункту анкеты необходимо ответить ДА или НЕТ
Назад
[{"lid":"1707750106606","ls":"10","loff":"","li_type":"rd","li_name":"Epilepsy","li_title":"6. \u042d\u043f\u0438\u043b\u0435\u043f\u0441\u0438\u044f ","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Epilepsy"},{"lid":"1707753894146","ls":"20","loff":"","li_type":"rd","li_name":"Blood","li_title":"7. \u041d\u0430\u0440\u0443\u0448\u0435\u043d\u0438\u0435 \u0441\u0432\u0435\u0440\u0442\u044b\u0432\u0430\u043d\u0438\u044f \u043a\u0440\u043e\u0432\u0438 ","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Blood"},{"lid":"1707753932944","ls":"30","loff":"","li_type":"rd","li_name":"Infectious","li_title":"8. \u0418\u043d\u0444\u0435\u043a\u0446\u0438\u043e\u043d\u043d\u044b\u0435 \u0437\u0430\u0431\u043e\u043b\u0435\u0432\u0430\u043d\u0438\u044f (\u0412\u0418\u0427, \u0413\u0435\u043f\u0430\u0442\u0438\u0442 \u0421)","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Infectious"},{"lid":"1707754263820","ls":"40","loff":"","li_type":"in","li_name":"InfectiousYES","li_title":"\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u0430\u043a\u0438\u0435?","li_nm":"InfectiousYES"},{"lid":"1707753997729","ls":"50","loff":"","li_type":"rd","li_name":"Dizziness","li_title":"9. \u0413\u043e\u043b\u043e\u0432\u043e\u043a\u0440\u0443\u0436\u0435\u043d\u0438\u0435, \u043f\u043e\u0442\u0435\u0440\u044f \u0441\u043e\u0437\u043d\u0430\u043d\u0438\u044f, \u043e\u0434\u044b\u0448\u043a\u0430 \u043f\u0440\u0438 \u0432\u0432\u0435\u0434\u0435\u043d\u0438\u0438 \u0430\u043d\u0435\u0441\u0442\u0435\u0442\u0438\u043a\u043e\u0432 \u0438\u043b\u0438 \u0434\u0440. \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0445 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u043e\u0432","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Dizziness"},{"lid":"1707754346632","ls":"60","loff":"","li_type":"in","li_name":"DizzinessYES","li_title":"\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u0430\u043a\u0438\u0435? ","li_nm":"DizzinessYES"},{"lid":"1707754034726","ls":"70","loff":"","li_type":"rd","li_name":"Oncology","li_title":"10. \u041e\u043d\u043a\u043e\u043b\u043e\u0433\u0438\u044f","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Oncology"}]
Далее
3/5
По каждому пункту анкеты необходимо ответить ДА или НЕТ
Назад
[{"lid":"1707750106606","ls":"10","loff":"","li_type":"rd","li_name":"Radiation","li_title":"11. \u041f\u0440\u043e\u0432\u043e\u0434\u0438\u043b\u043e\u0441\u044c \u043b\u0443\u0447\u0435\u0432\u0430\u044f \u0442\u0435\u0440\u0430\u043f\u0438\u044f, \u0445\u0438\u043c\u0438\u043e\u0442\u0435\u0440\u0430\u043f\u0438\u044f \u0437\u0430 \u043f\u043e\u0441\u043b\u0435\u0434\u043d\u0438\u0435 10 \u043b\u0435\u0442 ","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Radiation"},{"lid":"1707754615792","ls":"20","loff":"","li_type":"in","li_name":"RadiationYES","li_title":"\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u043e\u0433\u0434\u0430?","li_nm":"RadiationYES"},{"lid":"1707753894146","ls":"30","loff":"","li_type":"rd","li_name":"Operations","li_title":"12. \u0411\u044b\u043b\u0438 \u043e\u043f\u0435\u0440\u0430\u0446\u0438\u0438","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Operations"},{"lid":"1707754680673","ls":"40","loff":"","li_type":"in","li_name":"OperationsYES","li_title":"\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u0430\u043a\u0438\u0435?","li_nm":"OperationsYES"},{"lid":"1707753932944","ls":"50","loff":"y","li_type":"rd","li_name":"Otherproblems","li_title":"13. \u0414\u0440\u0443\u0433\u0438\u0435 \u043f\u0440\u043e\u0431\u043b\u0435\u043c\u044b \u0441\u043e \u0441\u0432\u043e\u0438\u043c \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u0435\u043c, \u043e \u043a\u043e\u0442\u043e\u0440\u044b\u043c \u0432\u0430\u043c \u0438\u0437\u0432\u0435\u0441\u0442\u043d\u043e","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Otherproblems"},{"lid":"1707754263820","ls":"60","loff":"y","li_type":"in","li_name":"OtherproblemsYES","li_title":"\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u0430\u043a\u0438\u0435?","li_nm":"OtherproblemsYES"},{"lid":"1707753997729","ls":"70","loff":"","li_type":"rd","li_name":"Medications","li_title":"13. \u041f\u0440\u0438\u043d\u0438\u043c\u0430\u0435\u0442\u0435 \u043b\u0438 \u0432\u044b \u0432 \u043d\u0430\u0441\u0442\u043e\u044f\u0449\u0438\u0435 \u0432\u0440\u0435\u043c\u044f \u043a\u0430\u043a\u0438\u0435-\u043d\u0438\u0431\u0443\u0434\u044c \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0430","li_req":"y","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_radcb":"rb","li_nm":"Medications"},{"lid":"1707754791665","ls":"80","loff":"","li_type":"in","li_name":"MedicationsYES","li_title":"\u0415\u0441\u043b\u0438 \u0434\u0430, \u0442\u043e \u043a\u0430\u043a\u0438\u0435","li_nm":"MedicationsYES"},{"lid":"1707754034726","ls":"90","loff":"","li_type":"rd","li_name":"Pregnant","li_title":"14. \u0411\u0435\u0440\u0435\u043c\u0435\u043d\u044b \u043b\u0438 \u0432\u044b*","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_isownvariant":"y","li_defselitem":"1","li_radcb":"rb","li_nm":"Pregnant"},{"lid":"1707754888013","ls":"100","loff":"","li_type":"rd","li_name":"Breastfeeding","li_title":"15. \u041a\u043e\u0440\u043c\u0438\u0442\u0435 \u043b\u0438 \u0432\u044b \u0433\u0440\u0443\u0434\u044c\u044e \u0432 \u043d\u0430\u0441\u0442\u043e\u044f\u0449\u0435\u0435 \u0432\u0440\u0435\u043c\u044f*","li_variants":"\u041d\u0415\u0422\n\u0414\u0410","li_isownvariant":"y","li_defselitem":"1","li_radcb":"rb","li_nm":"Breastfeeding"}]
Далее
4/5
По каждому пункту анкеты необходимо ответить ДА или НЕТ
Назад
*Для женщин
[{"lid":"1707750106606","ls":"10","loff":"","li_type":"ta","li_title":"\u0414\u043e\u043f\u043e\u043b\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u043e \u043e \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u0438 \u043c\u043e\u0435\u0433\u043e \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u044f \u0441\u043e\u043e\u0431\u0449\u0438\u0442\u044c \u0441\u043b\u0435\u0434\u0443\u044e\u0449\u0435\u0435","li_rows":"2","li_nm":"\u0414\u043e\u043f\u043e\u043b\u043d\u0438\u0442\u0435\u043b\u044c\u043d\u043e \u043e \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u0438 \u043c\u043e\u0435\u0433\u043e \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u044f \u0441\u043e\u043e\u0431\u0449\u0438\u0442\u044c \u0441\u043b\u0435\u0434\u0443\u044e\u0449\u0435\u0435"},{"lid":"1707753360796","ls":"20","loff":"","li_type":"tx","li_text":"<strong>\u042f \u043f\u0440\u0430\u0432\u0438\u043b\u044c\u043d\u043e \u043e\u0442\u0432\u0435\u0442\u0438\u043b(\u0430) \u043d\u0430 \u0432\u0441\u0435 \u0432\u043e\u043f\u0440\u043e\u0441\u044b \u0430\u043d\u043a\u0435\u0442\u044b \u0438 \u043e\u0441\u043e\u0437\u043d\u0430\u044e, \u0447\u0442\u043e \u043e\u0442 \u0441\u043e\u0441\u0442\u043e\u044f\u043d\u0438\u044f \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u044f \u0437\u0430\u0432\u0438\u0441\u044f\u0442: <\/strong> <br \/>- \u0440\u0435\u0437\u0443\u043b\u044c\u0442\u0430\u0442\u044b \u043b\u0435\u0447\u0435\u043d\u0438\u044f;<br \/>- \u0433\u0430\u0440\u0430\u043d\u0442\u0438\u0438 \u043d\u0430 \u043a\u0430\u0436\u0434\u0443\u044e \u0440\u0430\u0431\u043e\u0442\u0443, \u0432\u044b\u043f\u043e\u043b\u043d\u0435\u043d\u043d\u0443\u044e \u0432\u0440\u0430\u0447\u043e\u043c. <br \/><strong>\u042f \u0437\u043d\u0430\u044e:<\/strong><br \/>- \u0447\u0442\u043e \u0432 \u0441\u043b\u0443\u0447\u0430\u0435 \u043f\u0440\u0438\u0435\u043c\u0430 \u043b\u0435\u043a\u0430\u0440\u0441\u0442\u0432\u0435\u043d\u043d\u044b\u0445 \u043f\u0440\u0435\u043f\u0430\u0440\u0430\u0442\u043e\u0432 \u043f\u0435\u0440\u0435\u0434 \u043f\u043e\u0441\u0435\u0449\u0435\u043d\u0438\u0435\u043c \u0441\u0442\u043e\u043c\u0430\u0442\u043e\u043b\u043e\u0433\u0430 \u043c\u043d\u0435 \u043d\u0430\u0434\u043e \u0441\u043e\u043e\u0431\u0449\u0438\u0442\u044c \u0435\u043c\u0443 \u043e\u0431 \u044d\u0442\u043e\u043c;<br \/>- \u0447\u0442\u043e \u0430\u043d\u043a\u0435\u0442\u0443 \u043e \u0437\u0434\u043e\u0440\u043e\u0432\u044c\u0435 \u043d\u0430\u0434\u043e \u0437\u0430\u043f\u043e\u043b\u043d\u044f\u0442\u044c \u0432\u043d\u043e\u0432\u044c \u043a\u0430\u0436\u0434\u044b\u0435 \u043f\u043e\u043b\u0433\u043e\u0434\u0430 (\u0432 \u0441\u043b\u0443\u0447\u0430\u0435 \u0438\u0437\u043c\u0435\u043d\u0435\u043d\u0438\u0438\u0306). "},{"lid":"1709148594922","ls":"30","loff":"","li_type":"tx","li_text":"\u0417\u0430\u043f\u043e\u043b\u043d\u044f\u044f \u0444\u043e\u0440\u043c\u0443, \u044f \u043f\u0440\u0438\u043d\u0438\u043c\u0430\u044e:"},{"lid":"1709152653462","ls":"40","loff":"","li_type":"cb","li_name":"1","li_req":"y","li_label":"<a href=\"https:\/\/zubnoi-doctor.ru\/personaldata\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: rgb(6, 69, 173); border-bottom: 1px solid rgb(6, 69, 173); box-shadow: none; text-decoration: none;\">\u0423\u0441\u043b\u043e\u0432\u0438\u044f \u043e\u0431\u0440\u0430\u0431\u043e\u0442\u043a\u0438 \u043f\u0435\u0440\u0441\u043e\u043d\u0430\u043b\u044c\u043d\u044b\u0445 \u0434\u0430\u043d\u043d\u044b\u0445<\/a>","li_nm":"1"},{"lid":"1709152817490","ls":"50","loff":"","li_type":"cb","li_name":"1","li_req":"y","li_label":"<a href=\"https:\/\/zubnoi-doctor.ru\/privacypolicy\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: rgb(6, 69, 173); border-bottom: 1px solid rgb(6, 69, 173); box-shadow: none; text-decoration: none;\">\u041f\u043e\u043b\u0438\u0442\u0438\u043a\u0430 \u043a\u043e\u043d\u0444\u0435\u0434\u0438\u0446\u0438\u0430\u043b\u044c\u043d\u043e\u0441\u0442\u0438<\/a>","li_nm":"1_2"},{"lid":"1709148821701","ls":"60","loff":"","li_type":"cb","li_name":"2","li_req":"y","li_label":"<a href=\"https:\/\/zubnoi-doctor.ru\/rules\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: rgb(6, 69, 173); border-bottom: 1px solid rgb(6, 69, 173); box-shadow: none; text-decoration: none;\">\u041f\u0440\u0430\u0432\u0438\u043b\u0430 \u043e\u043a\u0430\u0437\u0430\u043d\u0438\u044f \u043f\u043b\u0430\u0442\u043d\u044b\u0445 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438\u0445 \u0443\u0441\u043b\u0443\u0433<\/a>","li_nm":"2"},{"lid":"1709148828122","ls":"70","loff":"","li_type":"cb","li_name":"3","li_req":"y","li_label":"<a href=\"https:\/\/zubnoi-doctor.ru\/personaldataagreements\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: rgb(6, 69, 173); border-bottom: 1px solid rgb(6, 69, 173); box-shadow: none; text-decoration: none;\">\u0421\u043e\u0433\u043b\u0430\u0441\u0438\u0435 \u043d\u0430 \u043e\u0431\u0440\u0430\u0431\u043e\u0442\u043a\u0443 \u043f\u0435\u0440\u0441\u043e\u043d\u0430\u043b\u044c\u043d\u044b\u0445 \u0434\u0430\u043d\u043d\u044b\u0445<\/a>","li_nm":"3"},{"lid":"1709148839438","ls":"80","loff":"","li_type":"cb","li_name":"4","li_req":"y","li_label":"<a href=\"https:\/\/zubnoi-doctor.ru\/servicecontract\" target=\"_blank\" rel=\"noreferrer noopener\" style=\"color: rgb(6, 69, 173); border-bottom: 1px solid rgb(6, 69, 173); box-shadow: none; text-decoration: none;\">\u041e\u0431\u0440\u0430\u0437\u0435\u0446 \u0434\u043e\u0433\u043e\u0432\u043e\u0440\u0430 \u043d\u0430 \u043e\u043a\u0430\u0437\u0430\u043d\u0438\u0435 \u043f\u043b\u0430\u0442\u043d\u044b\u0445 \u043c\u0435\u0434\u0438\u0446\u0438\u043d\u0441\u043a\u0438\u0445 \u0443\u0441\u043b\u0443\u0433<\/a>","li_nm":"4"}]
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