Register to a family doctor!

Do you want a family doctor who will listen and offer you support and empathy? At Avangard-Med you find a true friend and partner in your journey to health.

We have a team of professional and dedicated family doctors, ready to support you at any point in your life.

Fill out the form

It’s easy to have a reliable and professional family doctor. Fill out the form and we will contact you very soon!

I, the undersigned

Last name*First name*Identification number (IDNP)*Birth date*SeriesBirth certificate/temporary identity document numberE-mail

Place of residence (domicile or residence)

Municipality/City/Village*Sector/District*Street, block, apartment*Contact phone*

To be completed if the application is submitted by a legal representative

Last nameFirst nameContact phone

I request to be registered

Clinic name*Doctor's full name

Method of registration

Primary registrationChange of family doctor within Avangard-MedChange of family doctor and Avangard-Med

Reason for changing registration

Change of place of residenceIt has been 6 months since the last registrationOther

Avangard-Med ensures the protection of personal data in accordance with the legislation of the Republic of Moldova, under the conditions provided by Law No. 133 of 08.07.2011 regarding the protection of personal data.

I accept and consent that my personal data will be processed by Ministry of Health, CNAM, and Medical Center 'Avangard-Med' under the conditions provided by Law No. 133 of 08.07.2011 regarding the protection of personal data. I confirm on my own responsibility that the data presented is accurate, and I am familiar with the provisions of the Regulation on the registration of a person with the family doctor within the medical institution providing primary medical assistance in the mandatory health insurance system.

I expressly give my consent for the Avangard-Med Medical Center to collect and process my personal data.