Please, be attentive while filling all necessary
data in the below-given form. If you don't rememder the exact data of an
event consult the documents. Remember the more accurate you data are the
more accurate your diagnosis is.
We take into consideration the forms written in Russian
or in English preferable in Russian.
Here is the questionnaire for cancer test-diagnosis:
Your full name
Date of your birth (day, month, year)
Time of your birth (as precise as possible)
Place of birth (if you were born not in Russia,
give your geographical coordinates)
Date and place of your first marriaqe
Date of your mother's birth
An exact date and place of any important
event from your life: divorce, the birth of a child, an operation, robbery,
the death of your close relatives and so on.
An exact data and place of any another important
event from your life: divorce, the birth of a child, an operation, robbery,
the death of your close relatives and so on.
Your height in centimeters
Your weight in kilograms
The payment was done (the date, the sum and number of postal order)
The questionnaires are processed only after receiving your postal
order!
Send this questionnaire with money order to:
Russia, 410600, Saratov, Post Box 3170, Igor Andreevich Ilyasov
e-mail: zeus@san.ru