Doctors and Healthcare Professionals Registration

Please enter all requested information marked as *

	First name *	Surname *	Title *	Titles after name
	Street Address *		City & Postcode *	Region *
				Praha Středočeský Jihočeský Jihomoravský Karlovarský Královéhradecký Liberecký Moravskoslezský Olomoucký Pardubický Plzeňský Ústecký Vysočina Zlínský mimo ČR / outside CR
	Phone number * Public information This information will be available to the public	Fax	Email * Public information This information will be available to the public	Website
	Facebook		Twitter
	Languages - Please choose at least one language
	CZ             SK             EN             DE             FR             RU             PL             ES             VN
	This information will be available to the public

Please enter the name and contact details of your current medical practice

* - Please provide at least one contact detail of your current employment/position

Education and Employment

Please enter all requested information marked as *

	School of Medicine or Medical Faculty * Please choose from the list below		Year of graduation *	Years of work experience
	1. lékařská fakulta Univerzity Karlovy 2. lékařská fakulta Univerzity Karlovy 3. lékařská fakulta Univerzity Karlovy Jiná univerzita Lékařská fakulta Masarykovy univerzity Lékařská fakulta Univerzity Karlovy v Hradci Králové Lékařská fakulta Univerzity Karlovy v Plzni Lékařská fakulta Univerzity Palackého Zdravotně sociální fakulta Ostravské univerzity
	Main specialism * Please press CTRL to select more specialisms	Sub-specialties Please fill in all your sub-specialty certifications	Number of sub-specialties	Are you a member of the Czech Medical Chamber? *
	Allergology Andrology Anesthesiology Balneology Cardiology Child Psychiatry Child Psychology Clinical Biochemistry Corrective Dermatology Dermatology Diabetology Endocrinology Epidemiology Farmakology Foniatry Gastroenterology genetics Geriatry Gerontology Gynecology Hematology Hepatology Imunology Infection Medicine Internal medicine Logopedia medical genetics Microbiology Nefrology Neonatology Neurology Neurosurgery Oncology Ophthalmology ORL Orthopedy Other Palliative Medicine Pediatric Dermatology Pediatry Physiotherapy Plastic Surgery Pneumology Practicing Physician Preventive Medicine Psychiatry Psychology Radiodiagnostic Reumatology Serology Sexuology Stomatology Surgery Urology Venerology		0 1 2 3	Yes No
	Previous employment (voluntary information)			CRB checked * Fitness to practice according to relevant professional standards valid in the Czech Republic
				Yes No
	Please provide details of your previous employment (voluntary information)

Treatment Charges

Please enter other relevant information you would like to be displayed in your personal profile at Medindex

Please enter all requested information marked as *

	Additional information
	Email * Non-public information This information will not be available to the public. Your email address will serve as your login ID. You can use different or the same email as your contact email address	Password *
	Yes: I would like to subscribe to the alert service on medical conferences and events.
	* I confirm that all the information I provided above is accurate and complete. I agree that medindex may store and use my Registration Data solely for the purposes of the Healh Proffesional Database. Medindex o.p.s will not sell or pass any of your details onto third parties. Medindex operates in accordance with the law of the Czech Republic. (For further information please visit: http://www.uoou.cz/uoou.aspx?loc=454&lang=en )
	Medindex, o.p.s is registered with the Office of the Personal Data Protection as required under the 101/2000 Personal Data Protection Act.