Documents
Documents and requests
The forms our patients need most often, with information about where to submit them and how long each process takes.
Declaration selecting a doctor, nurse and midwife
The main document used to register with our clinic. The declaration template is set out in a regulation issued by the Minister of Health and is the same throughout Poland.
- Where: at reception in either of our clinics.
- What you need: your PESEL number; for a child, the parent’s or guardian’s PESEL number is also needed.
- How long it takes: a few minutes, with help from reception.
Download the declaration form (PDF) (in Polish)
Request for access to medical records
Submit this when you need a copy of your records — for example, for a specialist, for ZUS or for your own use.
- Where: at reception — in person at either clinic or by post to our registered office.
- Cost: the first provision of medical records within the requested scope is free of charge.
- Who can submit a request: the patient, their legal representative or a person authorised in writing.
Authorisation to receive information and medical records
A document naming a person with whom we may share information about your health and your medical records. These are two separate permissions, and you may grant only one of them.
You can withdraw authorisation at any time — simply make a statement at reception. Without authorisation, we will not share information with anyone, including close family members.
Request for a medical certificate
Medical certificates for ZUS, schools, employers or public authorities are issued by a doctor. Please let reception know in advance if you need one — some certificates require an appointment.
Data protection
The rules for processing patient data are set out in our information notice. Questions about personal data protection — about the grounds for processing, retention periods and how your rights are exercised — should be addressed to the Data Protection Officer. Issuing copies of medical records is handled by Teledoctor reception: in person at either clinic or by post to our registered office.
Personal data protection (in Polish)How to contact us
Phone numbers for both clinics, messaging apps and reception hours are all listed on one page.
Contact and appointments