Registration with a general practitioner

Sign up form

Please fill in the form below. Fields marked with * are required.

Your personal information

Degree:
First name: *
Last name: *
Degree after name:
Gender: *
Insurance number: *
Telephone: *
E-mail: *
Nationality: *

Address

Residential address: *
City: *
ZIP code: *

Temporary address:
City:
ZIP code:

Others

Current general practitioner:
Current general practitioner’s address:
Insurance company: *
Note:

Select a registration type:

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Basic Programme

(formerly Registered patient)

Become a Real Doctor client in the Basic Programme and enjoy all the benefits that registration in the Basic Programme brings you.

Staff speaks English
Ensuring multidisciplinary care with specialists
Client's appointment for a specific date and time with the possibility of priority
Possibility of telephone consultations with a doctor within the reserved time limits
Possibility to use extra equipment in the doctor’s office beyond the frequency covered by public health insurance (sleep apnoea machine, ECG, CRP, INR analyser, etc.)
Discounts for health services not covered by public health insurance
15 % discount from the price list of all stays of the company Františkovy Lázně - Aquaforum, hotel Pawlik

Basic Programme membership price - 2500 Kč / year*

*By paying the amount for the first month you apply for the monthly subscription.
The stated prices are valid only under the conditions of concluding a contractual relationship for at least 1 year.

I consent to my personal data processing. * I agree with the general terms and conditions and internal rules of Ambulance Penta s.r.o. * I agree that Ambulance Penta s.r.o., which operate the True Doctor’s medical office will send me information, newsletters and other business communication. This will include information on medical care, services, offer of recommended prevention programmes and other commercial offers of the aforementioned companies. I may cancel receiving the information at any time. I wish to become the True Doctor’s registered patient. *