top of page
INTERSE_IKPPZ_sirka_bila.png

Book an examination - Adult Ambulance Jeseniova

Please fill out the following form and make a binding appointment for the examination.


Fill in the actual details of the person interested in the service

Date of birth
Month
Day
Year
Your insurance company
General Health Insurance Company - 111
Sectoral health insurance company - 207
Czech Industrial Health Insurance Company - 205
Škoda Employee Insurance Company - 209
District Brotherhood Fund – Health Insurance Company - 213
Health Insurance Company of the Ministry of the Interior - 211
I am a self-payer (or insured 201)
I come with a recommendation from: *
Crisis Center
Psychotherapist/ psychologist
Sexologist
Neurologist
Psychiatrist
At your own request/other
I am ordering for
CBT program for insomnia
Examination by a psychologist for adults (ONLY WITH A DOCTOR'S REQUEST)
Esketamine administration (ONLY WITH A PSYCHIATRIST'S REQUEST)
Neuropsychological examination for adults (ONLY WITH A DOCTOR'S REQUEST)
I need help with
Gender issues
Mood disorder – depression
Anxieties
Developmental disease
Attention deficit disorder
Memory disorders
Other, please fill in.

Contact

ambulance@intersepraha.cz

+420 731 904 995  

​data box: t7nj6tz

​Ambulance for adolescents and adults
Jeseniova 1226/139
​raised ground floor

​Nearest tram stop

Žižkov depot approx. 3 minutes walk (200m)

Trams number: 1, 10, tram 11, 9

If you are driving, you can park in the blue zone (there is usually enough space)

​Documents for download

​Interse Internal Rules

bottom of page