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Form for the owner

The form is dedicated to the Owner. Complete it to the best of your knowledge. If necessary, attach the rtg / usg / ct or other file.

Fields marked (*) are required. After sending the form, you will receive a copy via e-mail. If you don’t receive it, please contact us.
After verification, we will contact you to arrange a consultation.

Ask your doctor to complete the Referral Form. It is obligatory.


    OPIEKUN:

    Jestem zainteresowany/a zakwaterowaniem w Ośrodku RTWet na czas leczenia mojego zwierzęcia *

    taknie


    PACJENT:

    Stan bieżący Pacjenta *

    stan ogólny dobrysilny bóldusznośćnie jesłaby apetytbiegunkiwymiotyproblemy z oddawaniem moczuinne


    LEKARZ PROWADZĄCY:


    PLIKI:

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    Dołącz plik (max. 3MB)

    The administrator of personal data is RTWet Sp. z o. o., NIP 7010712036. Using the form is tantamount to consenting to the processing of personal data contained in the form for the purposes necessary to sign up for consultation and possible treatment of the animal (in accordance with the Act of August 29, 1997 on the Protection of Personal Data; consolidated text: Journal of Laws of 2002, No. 101, item 926, as amended). The data will not be processed for other purposes and will not be transferred to third parties without your consent. You have the right to request access to your personal data, rectification, deletion or limitation of processing, as well as the right to object to the processing, as well as the right to transfer your data and submit a complaint to the supervisory body.