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.

 

1. Registration Form

  • Personal Information

  • Contact Information

  • Emergency Contact Information

  • Insurance Details

  • Laboratory results

  • :
    Please review our pricelist: firstmedcenters.com/pricelist
    I hereby declare that I have read and accept the terms of the Privacy Policy of Firstmed-FMC Egészségügyi Szolgáltató Korlátolt Felelősségű Társaság (seat: 1015 Budapest, Hattyú utca 14., company register: 01-09-958986, referred to as “Data Controller”) based on Directive (EU) 2016/679 (GDPR) of the European Parliament and the Council. Having been sufficiently informed on the subject I consent by my own free will and give authorization to the handling and checking of my involved personal data - in compliance with the Privacy Policy – to the Data Controller.
    From time to time we would like to let you know about special offers, contests, news updates. May we contact you via email? Consent may be withdrawn at any point.
  • *You should get an email after your registration. FirstMed will never share your Email address or any personal information with a third party.

    If you cannot find the confirmation email in your inbox - please check the spam folder as well, call us at +361-224-9090 for more information. Thank you!
  • 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.

1. 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.