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FAMILY DOCTOR, PEDIATRICIAN

Consultation on NFZ (za 0 zł*) Family Doctor / Pediatrician (private) (za 99 zł)

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APPOINTMENT REGISTRATION FORM

Select Service and Visit Type

Select service / doctor *

Patient Information

First Name *

Last Name *

PESEL / ID Number *

Contact Details and Address

Phone Number *

Email Address *

Street

House No.

Apt No.

Postal Code

City / Town

Date and Additional Notes

Preferred Date of Visit *

Additional notes / symptoms description

Patient Consents and Declarations

Granting the following consents by the patient is voluntary, however their absence prevents the provision of services by the Medical Entity.

* I declare that I have read the Regulations of the Euromedica Group via www.przychodnie-grudziadz.pl, accept them and meet the conditions set out therein, including being at least 18 years old. * I voluntarily consent to consultations or other health services and the resulting processing of my personal data (Art. 9(1) GDPR) provided in the medical form by: NZOZ Euromedica Sp. z o.o., "J.K.-21" Sp. z o.o., NZOZ Tivoli-Med. s.c. (as controllers) for healthcare provision. I consent to receiving marketing and commercial information from Euromedica Group (service promotions, goods, event notices) via email, SMS, MMS, and incoming calls to the provided phone number. * Pursuant to Art. 7 GDPR (EU 2016/679), I consent to the processing of my personal data in the declaration by NZOZ Euromedica Sp. z o.o. (ul. Dąbrówki 1, Grudziądz) for providing medical services and telehealth consultations in primary healthcare.

* NFZ consultation requires the patient to submit a primary healthcare choice declaration for a doctor, nurse, and midwife. Upon filling and signing the declaration, the person becomes a patient of one of e-poz.com facilities.

Make an appointment with a doctor quickly and conveniently

Choose Consultation Type

Fill in the Form

Book Your Visit

Await Contact

Make an appointment with a doctor
quickly and conveniently