Application Form

After receiving your contact data we will be glad to call you back to make an appointment directly. Please fill in your name and your telephone number(s).

Please note that we are only active on private-medically or self payer basis. A permission for legal health insurance doesn't exist.

We apologize that we might call you back in the evening because of staffing bottlenecks which are possible during our regular consultation hours.

Form of Address

Title

First Name*

Last Name*

Phone Number*

or Mobile Number

E-Mail*

Remarks

Note

We request your understanding for our not being able to answer specialist medical questions from unknown patients by e-mail. We prefer personal contact over e-mail, even for patients who are known to us.

« back