Welcome to the VIOS Clinic Registration
This form will create a user profile to help us process your booking application. Data provided in this form will not be shared with any third party entity not affiliated with ViOS, Inc or its processes. You may request to delete a completed form at your convenience by contacting connect@viosapp.com.
メールアドレス *
Profile Name (You may provide an alias or only your first name)
Are you inquiring about a pre-diagnosed health issue related to the field of surgery? Please confirm you are seeking a consult with Dr. Luis. *
During your scheduled Zoom meeting, Dr. Luis will give you an expert second opinion, lifestyle counselling or non-surgical consultation for your health/medical needs. Do you agree? *
Dr. Luis will NOT be providing a primary diagnosis (without a prior physical exam) for your health concerns, complaints or surgical needs. *
Dr. Luis will NOT provide you any form of online prescription. You may discuss any treatment plan or prior prescriptions given to you by your local surgeon or doctor. *
Is this booking for yourself, or on behalf of someone else? *
Which city will you be joining from? eg. London *
If you would like to discuss your health records (reports, scans, tests, prescriptions etc), please scan them, save it on your desktop & you may screen share them with your Provider *
I agree to the terms and conditions set by ViOS, Inc. https://www.viosapp.com/disclaimer/ *
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