Patient registration

	Red-framed fields must be filled-in.


Titles		Nápověda: Do you have any additional titles? Do they precede your name? It does not matter; all titles will be recognized accordingly and affixed appropriately.

Name

Surname


Birthdate		Nápověda: The birth date can be given in the format DD.MM.YYYY or YYYY-MM-DD.


E-mail		Nápověda: The e-mail address has to be validated. After the registration a validating e-mail will be sent to the address you have provided us.

Mobile phone		Nápověda: Please provide a valid phone number as the reservation confirmation will be done by using the contact information which you have provided.


Password		Nápověda: The password has to be at least six characters long.

Re-enter your password		Nápověda: The password has to be at least six characters long.