PL / EN

on-line REGISTRATIONA

After receiving a message from you, our employee will contact you to determine the date and conditions of rehabilitation.

Formularz rejestracji

 

Rodzaj świadczenia *
Imię i nazwisko pacjenta *
Płeć *
Data urodzenia
E-mail address *
Telefon kontaktowy *
Adres *
Miasto *
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).