Details of the new request

{ERROR_MESSAGE.text_error_message}

What conditions or concerns are you seeking the second opinion for ? (*)

{sog_problemdescription_fld}
Total words left (500)

Your Questions (*)

Your Questions (*)

Your Medical Information

My Past Health History (PaHH)
My Present Health History (PHH)
My Family Health History (FHH)

Attachments

You can upload here or send via Mail
I am mailing my medical records.

Your Order

Reference # {reference_job}
Specialization {specialisation_job}
Selected Plan {selected_plan}
Cost $ {cost_plan}
Other charges $ 0
Total $ {total_cost_plan}
OPTION TO MAIL COPIES OF YOUR MEDICAL RECORDS
In case you are unable to electronically upload your medical records via our website, please mail copies of ALL of your medical records/scans that you want our medical expert to review at the following address for a small handling and processing fee.

Please write your customer reference number on all your correspondence.

Second Opinion Global, Inc.
2821 83rd Street
Darien, Illinois 60561 U.S.A.

{sog_csrf_fld}