Contact form - CM Luxmed Lublin

Name *:

Last name *:

Company name:

Select contact method:

- e-mail
- correspondence address

Street *:

House number *:

Apartment number:

Zip code *:

Town *:

Email *:

Contact telephone number:

order
/payment number *:

Select the facility
where the benefit was provided or was to be provided *:

Content of the application *:

If the report concerns treatment undertaken at the Luxmed Medical Center and continued outside the facility, the report must be accompanied by a copy of the medical records (including test results) from the treatment outside the Luxmed Medical Center facilities.

Attachment:

I accept the complaints regulations