For information, contact the program coordinator.
* Name:
* Name:
* Date of birth:
* Contact phone:
Email address:
Have you used a sports medicine clinic under your insurance?
YES, when     where
* The sport discipline for which the qualification will be made:
* Notes:
* mandatory fields

Updated information on the processing of personal data is contained in the document Rules for the Processing of Personal Data at CM Luxmed

The rules regarding the processing of data on Luxmed websites are set out in our Privacy Policy