Pre-booking form for an appointment Please leave this field empty. Name and surname E-mail Phone Select a doctor (optional) - Select - Katarzyna Rumińska Piotr Liberski Rafał Twardy Stanisław Gajda Sylwia Tomicka Proposed date of visit Proposed time Message or question I agree to the processing of my personal data by "Pierwsza Prywatna Klinika Stomatologiczna DR N.Med.Stanisław Gajda" for the purpose necessary to provide service to this query. I have read the information about the processing of my personal data in privacy policy and accept its provisions. How to get to us?