Registration

To register at FirstMed please complete and send the online Registration Form (pdf) and the Medical Information Release Consent Form (pdf) below. Should you prefer completing them by hand, please print out the pdf versions above and bring them both for your visit.

Exclamation_mark_redPlease note that it is necessary to click both blue fields at the end of each form in order for our colleagues to receive them both.

 

Registration Form

  • Personal Information

  • Contact Information

  • Emergency Contact Information

  • Insurance Details

  • Laboratory results

  • :
  • * FirstMed will never share your Email address or any personal information with a third party.

  • This field is for validation purposes and should be left unchanged.

Exclamation_mark_redIt is important that you click on the blue button above before continuing the registration, otherwise the above form will be lost. Thank you.

Medical Information Release Consent Form

I hereby acknowledge that FirstMed-FMC Kft. may hand over medical documentation related to me to the person and/or in the manner I have designated in this declaration. The medical documentation shall be deemed as handed over to me – in case of personal delivery, by the delivery, in case of an e-mail, by the sending, and in case of registered mail, by the sending. Therefore, as long as my instructions as stated herein are followed, I may not raise any claims against FirstMed-FMC Kft. regarding the handing over of my medical documentation, and I may not claim that FirstMed-FMC Kft. has breached my privacy rights with regard to the disclosure of my medical documentation.