Registration

We look forward to your registration through your GP. New patients are kindly asked to use the registration form.

We ask yout to make cancellations only via email or phone (VM); unfortunately SMS/Whats App cannot be accepted.

Please complete the fields marked with a red star *

Bitte lasse dieses Feld leer.
Referring physician / GP *

Personal Data:

Last Name *

First Name *

Date of Birth *

Gender *

Street *

Postcode / City *

E-Mail *

Phone home / mobile *

Health insurance company *

Please bring your health insurance card with you to the first appointment.

General practitioner model?*
yesno

Your concern

Agreement: *

I agree, that missed appointments that are cancelled less than 48 hours before the arranged time must be invoiced (no settlement by the health insurance company).
I confirm that I have read the privacy policy.