cancer treatment case compatibility, brachytherapy case compatibility

Name *

First Name *

Email *

Country *

Your age *

Your Gender *

Your Disease is *

In case of cheloid scar, please specify

Please upload a photo of your scar here

In case of cancer please specify wich organ is affected (breast, prostate, skin, liver, lung, ....) *

If you already know the stage of your disease please specify

Am I compatible for treatment by Brachytherapy?