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Logo - Všeobecná zdravotná poisťovňa Logo - Všeobecná zdravotná poisťovňa
English Provisional replacement certificate

Application form for a Provisional replacement certificate for the European Health Insurance Card (EHIC)

Slovenská verzia Deutsche Version

We offer a quick and reliable way to apply for Replacement certificate for the European Health Insurance Card (EHIC) for clients of Všeobecná zdravotná poisťovňa, a.s., who have received health care in your hospital or ambulance. If you wish for a replacement certificate, please, fill out the online form. Before sending this application, ask the patient to submit another identification card containing his/her personal data.

Name of the foreign health care provider required field
Address of the foreign health care provider required field
Phone number required field, allowed numbers
E-mail contact required field, e-mail address in format name@domain.com
Firstname is required field
Surname is required field
Date of birth required field, date in format dd.mm.yyyy
Identification number is required field, allowed numbers
Address in Slovakia (street, number, city/town) is required field
From is required field, date in format dd.mm.yyyy
To is required field, date in format dd.mm.yyyy
Data marked with an asterisk are mandatory