Preventive examinations – form

Madam,

We cordially encourage you to undergo preventive tests at the National Institute of Oncology-PIB in Warsaw.

Please complete the form below.
We will call you back, let you know what tests you are entitled to and arrange a date for the tests.

Aby wypełnić ten formularz, włącz obsługę JavaScript w przeglądarce.

PESEL *

Nr telefonu *

E-mail *

Potwierdzam, że zapoznałem(-łam) się z Polityką prywatności. *

• TAK

Wyślij

Privacy policy

* The data is necessary only to arrange an appointment for the indicated examination, it will not be used for other purposes. NIO-PIB will contact you by phone within 48 hours (applies to business days).