I am close to the patient

your data

Date of birth*

Information about the diagnosis of a loved one*

Medical documentation confirming the diagnosis

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Type of consultation*

Psycho-oncologistPsychiatristOncodietitian

Statements
I declare that all documents attached to the application are true to the original and that the data contained therein reflect the actual state of affairs and I consent to their disclosure to the foundation for verification purposes, if necessary (required)
I consent to the processing of my data in accordance with the applicable provisions on personal data, in particular the Regulation (EU) 2016/679 of the European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of personal data and on the freedom to the flow of such data and repealing Directive 95/46/EC (Journal of Laws UE.L No. 119) and the Act of May 10, 2018 on the protection of personal data (Journal of Laws of 2018, item 1000). I understand that providing data is voluntary and necessary to provide support offered by the Rakiety Oncological Foundation. At the same time, I declare that I have read the information clause of the Rakiety Oncological Foundation in connection with the processing of personal data. (required)
I consent to receiving commercial information (Newsletter) electronically to the e-mail address provided by me within the meaning of Art. 10 section 1 of the Act of July 18, 2002 on the provision of electronic services from the Rakiety Oncological Foundation.

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