Dear Patient!

Thank you for filling in and accepting our privacy statement, which we have prepared to protect your data in accordance with GDPR rules.  

If you have requested an examination for your child, please write the child's name (as a patient), date of birth, address and social security number into the related sections of the form. The e-mail address and telephone number must be the contact details of the parent/legal representative!

Panoráma Polyclinic

If you wish to fill in the form in English, please click here!