To become our Patient, simply fill out declaration, available at each of the NZOZ "Twój Lekarz" facilities. When filling out the declaration, you must select a primary care physician and nurse, as well as a midwife.
When completing the declaration, please provide:
- your name and surname,
- date of birth,
- residential address,
- telephone number,
- PESEL number.
The documents required when completing the declaration are:
- identity card,
- health insurance document.
INSURED:
- in the case of employees: a current RMUA form or, if it is not possible to obtain it, a currently stamped insurance card (valid for 30 days);
- in the case of persons running a business activity: current proof of payment of health insurance contribution;
- in the case of farmers insured with KRUS: current certificate from KRUS on health insurance contributions paid;
- in the case of pensioners: pensioner's ID;
- in the case of pensioners: pensioner's ID card;
- in the case of unemployed persons registered with the employment office: a certificate from the employment office on payment of health insurance contributions (valid for 30 days);
- in the case of a person receiving a permanent benefit from social assistance: a certificate from MOPS and confirmation of the last benefit payment;
- in the case of a person receiving a pre-retirement allowance or pre-retirement benefit: a decision or certificate from the Social Insurance Institution (ZUS) confirming registration with health insurance and confirmation of payment of the last benefit;
- in the case of persons covered by voluntary insurance: current proof of payment of the health insurance contribution
FAMILY MEMBER (e.g. pupil, student, non-working spouse):
- a document confirming the health insurance of the person who registered the family member for health insurance (see above) and
- proof of registration for health insurance (ZUS ZCNA, ZUS ZCZA form) or a certificate from the payer about registration of a family member (must include the date of registration),
- in the case of persons over 18 years of age: a document confirming continued education (e.g. school or student ID) or significant disability.
Documents (originals) should be stamped and signed, and copies should be certified as true copies.
The staff of NZOZ "Twój Lekarz" (Your Doctor) assists in completing the declaration.
When registering a child, please provide the details of the guardian registering the child for insurance.
