Email :


Individual test assignment service

is aimed both for both patients registering for first appointment with dr. Cubala*, as well as people only interested in performing tests. More information regarding the first visit can be found in Regulations. We sincerely ask you to become acquainted with it.

*Applies to patients with symptoms of, diagnosed, or suspected autism. Patients with other diseases are asked to contact us at


Before beginning, we ask that you familiarize yourself with the Regulations, where you will find detailed instructions for filling out the questionnaire (section 1 of the Regulations).
1. In order to begin the process, please download and fill out the questionnaire, according to Regulations – click here to download the questionnaire

2. Please email the following information to, with the subject “Test assignment” or child’s full name:
– Questionnaire, properly filled out in Microsoft Word on a PC (with the exception of the last page, which should be filled out by hand)
– Consent form for the tests, filled out and signed
– Optionally: lab test results – only those differing from reference values (as a PDF file)
– Optionally: biomedical test results (metabolic urine analysis, comprehensive stool analysis, hair analysis) not older than a year (as a PDF file)
– Bank transfer confirmation, in the amount of 200 PLN (as a PDF or JPEG file)

3. Please send signed master copy of the consent for by a registered letter or bring it personally to: Arcana INTEGRATIVE MEDICINE, Kniaziewicza 45/10, 05-500 Piaseczno. The master copy must be received within 14 business days of sending the form.

Please do not send a printed questionnaire or test results – only the signed consent page.

The date of registration is considered as the day of emailing all required documents:
– filled out questionnaire
– scanned consent form
– and bank transfer confirmation.