A licensed doctor reviews your answers before recommending this treatment.
Step 1 of 5: About you
Patient details
Enter a date up to 04/11/2026.
Identity
Your rodné číslo — it is also your health insurance number, and the doctor needs it to arrange electronic treatment.
Required on Czech clinical records. Your rodné číslo stays optional.
Your Czech public health insurer. The doctor needs it to arrange electronic treatment you can collect at any Czech pharmacy.
Vaše cesta
Part 1 of 3
Tento formulář je určen pro tablety proti malárii na plánovanou cestu. Uveďte prosím itinerář co nejpodrobněji. Správný lék totiž hodně závisí na tom, kam přesně a kdy pojedete, nejen na názvu země.
Patient address
Required for medical documents and any physical materials.
In an address written Rybná 716/24, 716 is the číslo popisné and 24 the číslo orientační. Either one on its own is enough.
Review
Data sharing consent (GDPR)
