EmailMeForm
Prostate Consultation Dr Díaz drGdiaz.com
All fields are required
The patient must be over 26 years old
This form is limited to consultations about prostate, male urinary tract and genitalia
We will do our best to help you. However our advice depends on the information provided by you so we are not liable for results
We do not provide any information for conferences, works, assumed issues, etc. We do not explain exams we have not recommended
If you do not mention any symptom we understand you need preventive advice
Just write down your exams' conclusion, not the whole exam
By submitting this form you agree to these terms
Name
*
First
Last
Age
*
Country
*
City
*
occupation
*
Email
*
Verify your email
Celular
*
Phone
*
Motive
*
High PSA
You were diagnosed with cancer
Have blood in your semen
Prevention
Wanto to avoid biopsy
You have a biopsy already done
They want to remove your prostate
Infertility
Sexual Dysfunction
Testicle
Penis
Other
Unicamente seleccione el principal motivo por el cual consulta
PSA
Last PSA results. No decimals. If you have no PSA done, type 0
Gleason
Biopsy results. If no biopsy has been done, type 0
Message
*
briefly describe your symptoms