Basic information
Correspondence address
Ladies and Gentlemen, answering the questions contained in the survey below will allow us to choose the right diagnostic and medical consultation proposal for you. Participation in our free research programs is completely voluntary.
Please list all medications you are currently taking along with the doses:
I consent to the processing of my personal data, including sensitive data, based on the GDPR Art. 6 point a. in order to protect my health, provide medical services to me and conduct medical clinical trials by the Centrum Badań Klinicznych PI-House sp. z o.o. with headquarters in Gdańsk, ul. Na Zaspa 3. Consent to the processing of my personal data also includes consent to their processing in the future, provided that the purpose of processing does not change. I have been informed about the right to view and correct data and to obtain information on the data collected. At the same time, I agree to the use of my data, including sensitive data, to: inform me about the possibility of participating in free preventive examinations, assessing the possibility of qualifying me for clinical tests and inviting me to participate in such examination. I agree to receive information about the offer of preventive tests or clinical tests and about upcoming visits to the PI-House Clinical Research Center with the use of means of distance communication in the form of telephone contact, email, sms or written notification addressed to the address I provided. I consent to the processing of my data for the purposes and scope indicated in this consent in IT systems.