+420 244 403 114

Poliklinika Soukalova 3/3355, 143 00 Praha 12 – Modřany

For new clients

Dear parents,

If you consider registration of your child at our pediatric office, and if, prior to the registration, you would like to ask us about our approach to vaccination, we would like to assure you that in compliance with the newest knoweldge and guidelines in medicine, we consider vaccination as a crucially important means of prevention of serious illnesses in childhood and adolescence.

Our pediatric office provides children with highly individualized health care. The above-standard services, that are not covered by the public health insurance, are covered by annual membership fees in our pediatric office.

Form for new patients

    Child's Information

    Mother's Information

    Father's Information

    Emergency Contact Person

    Additional Information about the Child

    Dear Parent, in order to provide high-quality healthcare for your child, we kindly ask you to provide the following information about your child: