Please fill the form to make an appointment.
1. Please enter your name
2. Please enter your email adress
3. Please enter your phone number
4. Please specify type of treatment or consultation
5. Additional information
6. Personal data procession consent.
Under Article 23 section 1.1 of the Act of 29 August 1997 on personal data protection (JoL from 2002 no. 101 item 926), I give my consent to my personal data being processed for the purposes of medical treatment registration by NZOZ Eskulap, ul. Cicha 41 in Bydgoszcz. Pursuant to the Act of 18 July 2002 on electronic provision of services (JoL from 2002 no. 144 item 1204). I give my consent to sending me electronic correspondence related to medical treatment registration. I have the right to access my personal data and correct them. Data have been provided on a voluntary basis.