My Web Radiologist

Registration form

Franšais

Please complete all fields below

Name of the clinic or physician's name   *
Person in charge   *
E-mail address   *
Phone number  
Doctor's practice number   *
Language   Fr   En

* Fields required

You will then receive an acces code and a temporary password by e-mail as soon as possible.

In case of difficulties, please contact the service administrator.

 

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