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Documentation for teleportation

Send documentation no later than one hour before your appointment.
Name:
Name:
PESEL:
No PESEL number:
Date of birth:
Name of service / clinic:
Type of service:
Doctor:
Date of visit:
Email:
Annex:
Annex:
Annex:
Annex:


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I have familiarised myself with the rules of providing health services at CM Luxmed.

Information on the processing of personal data is provided in the Privacy Policy