For the convenience of patients and easier access to network services NZOZ Your Doctor, we are introducing simplified procedures for submitting a declaration of choice of a clinic, which eliminates the need to visit the facility in person. You can now easily fill out, sign and submit all the necessary documents, even without leaving your home. 

Patients can use one of several available methods to submit their declaration: electronically with a secure TRUSTED SIGNATURE, electronically using a simple signature, or, for those who prefer a more traditional approach, by delivering the documents in person. Each of these methods offers simplicity and flexibility, allowing you to choose the option that best suits your individual needs and preferences.

Want to learn more? Visit the BECOME OUR PATIENT tab.

ELECTRONIC METHOD USING A TRUSTED SIGNATURE /ePUAP/

Step 1: DOWNLOAD AND COMPLETE THE DECLARATION ELECTRONICY

Download the appropriate declaration form and complete the document directly on your computer.

Step 2: SIGN THE DECLARATION ELECTRONICY

Use Trusted Signature to sign a document. Instructions on how to obtain and use Trusted Signature can be found on the given page.

Step 3: SEND AN ELECTRONIC SIGNED DOCUMENT

Send the electronically signed document to our email address: declarations@twojlekarz.net

ELECTRONIC METHOD WITH A STANDARD SIGNATURE 

Step 1: DOWNLOAD AND COMPLETE THE DECLARATION

Download the appropriate declaration form.

On your computer, complete all required form fields.

Step 2: PRINT AND SIGN THE FORM

After completing the form, print it out and sign it in the space provided.

Step 3: SEND SIGNED FORMScan the signed form and then send the file to the following email address: declarations@twojlekarz.net

TRADITIONAL METHOD – PERSONAL DOCUMENT SUBMITTAL

Step 1: DOWNLOAD AND COMPLETE THE DECLARATION

Download the appropriate declaration form and complete all required fields.

Step 2: PRINT AND SIGN THE FORM

After completing the form, print it out and sign it in the space provided.

Step 3: TAKE THE DECLARATION TO THE CLINIC 

Submit the completed and signed declaration in person at the reception of any NZOZ Twój Lekarz facility. 

If you need help with the declaration process, please contact our helpline at 71 311 12 36, Monday to Friday 10:00 a.m. - 6:00 p.m., or via e-mail: biuro@twojlekarz.net. We are here to help you!