Reception

If you have an acute problem, immediately call our 24hrs emergency

on (+420) 224 228 994!

Name, Surname *
Are you patient of EDC? *
Date of your last visit in EDC *
Date of your last visit to stomatologist *
Email
Phone
Birth date *
Sex *
Are you from other country than CR? *
Mother tongue *
I also speak
Way of payment *
Acute problems *
Do you have chronic diseases? *

(Illnesses of heart, a high blood pressure, thyroid gland, icteric discoloration, allergy, etc.)

Medicines you take (including contraception)
Notes
Puprose of visit *
Other purpose
Required date of meeting *
Own documentation (X-ray) *

Schnelle Kontakt

tel: (+420) 224 22 89 84

tel: (+420) 224 22 89 93-4

Email: edc@quick.cz

Reception

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Reception

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