E-Reservation, Luxmed Lublin - specialist doctors, research...

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Deadlines may vary depending on the type
of service provided (subscription, NHF, paid service)

New patient

Name:
Name:
Pesel:
Date of birth:
ID card:
Passport:
Country:
Zip code:
Locality:
Street:
	My address details are missing from the list, I want to fill in manually
House no:
Premises no:
Country prefix
Mobile (without the zero at the beginning):
Email address:
Payer:
Contractor:
Contract:

Service unavailable at selected location or no free appointments
Select another facility

In order to submit error information, it is required to fill in the following fields.
Email address:
Bug description:
Appendix: