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Make an appointment for an examination - Children's Ambulance Olšanská

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 (for children, please provide the contact information of the legal guardian, but not the child's details)

Date of birth
Month
Day
Year
Vaše pojišťovnaYour 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: *
Pediatrician
Ped. psych. counseling
Crisis Center
OSPOD (social and legal protection authority for children)
Psychotherapist/ psychologist
Sexologist
Neurologist
At your own request/other
I need help with
Gender issues
Mood disorder – depression
Anxieties
Developmental disease
Attention deficit disorder
Memory disorders
Other, please fill in.
I am ordering for
CBT for insomnia group
Examination by a psychologist for adults (ONLY WITH A REQUEST FROM A PSYCHIATRIST)
Esketamine application (if you do not submit a request from your doctor, it is not possible to apply for the application)
Neuropsychological examination for adults (ONLY WITH A DOCTOR'S REQUEST)

Please include all available reports from professional examinations (PPP, SPC, neurologist, psychiatrist) regarding the child's mental state, which are necessary to ensure support and care.

Contact

centrumprodeti@intersepraha.cz

+420 733 630 950

​data box: t7nj6tz

​Ambulance for children from 0 years old
Olšanská 2666/7, Prague 3, 103 00
​Polyclinic Olšanská 5th floor

​Metro A Želivského

Trams number 5, 9, 26 and 10, 11 go there

If you are driving, you can park in the parking lot in front of the clinic or in the parking zones.

​Documents for download

​Interse Internal Rules

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