online REGISTRATION

When we receive your message, we will get in touch to establish the dates and conditions of your rehabilitation program.

Simply fill in the form and make sure to leave your contact details, then wait for a call or message from us.

Registration form

Type of service *

Patient's first and last name *

Sex *

Birth date

E-mail address *

Phone number *

Address *

City *

Message

I agree to receive marketing communications via e-mail from Rehamed-Center Sp. z o.o. in accordance with the Regulation of the European Parliament of 27 April 2016 on the protection of individuals with regard to the processing of personal data and on the free flow of such data (General Data Protection Regulation – GDPR, OJ L 119, p.1) and in and the Act of 18 July 2002 on the provision of electronic services (Journal of Laws of 2002, No. 144, item 1204, as amended).