NZOZ "Your Doctor" provides medical services in the field of Primary Health Care under the contract with National Health Fund. Patients who wish to use them are required to submit a declaration of choice of clinic.
Due to the pandemic COVID-19 we recommend:
- downloading the document from our website,
- carefully complete, print and sign the form,
- sending a scan of the signed declaration to the address declarations@localhost
Documents to download:
DECLARATION – WOMAN
DECLARATION – MALE
DECLARATION – male newborn up to the age of two months
ATTENTION!
IN THE DOCTOR, NURSE AND MIDWIFE SELECTION FIELDS, THE NAMES OF THE MEMBERS OF THE NZOZ YOUR DOCTOR TEAM RESPONSIBLE FOR SUPERVISING THE INDIVIDUAL DEPARTMENTS WILL APPEAR. ENTERING A SPECIFIC NAME DOES NOT LIMIT PATIENTS FROM USING THE SERVICES OF THE ENTIRE FACILITY STAFF.
We also inform that people with Individual Patient Accounts can submit declarations to the clinic electronically, via this system. Declarations of accession to the clinic can also be completed and submitted in person at all NZOZ Twój Lekarz locations.