Create žádost o očkování

PATIENT

*
how can we contact you if needed?
we recommend selecting the EMAIL option so you can get more information on vaccinations (we do not send any information via SMS)
we do NOT send any automatic confirmation
fill in your email address @

VACCINATION

fill in if you wish to send the prescription by SMS

CONSENT

By submitting the form, you consent to the processing of personal data contained in the form.
In accordance with the GDPR, this data will be used exclusively for the purposes of planning vaccination in this office and will not be provided to third parties.

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by Dr. Radut