Treatment Inquiry & Appointment

Dear patient, dear requestor,

please note that we cannot deal with your inquiry unless you provide us with this form completed in English, German, Russian or Arabic and the necessary medical reports in English or German only.

Please complete this form in English, German, Russian or Arabic.

Kontaktformular/contact form/контактный формуляр

Patient Data

Medical Information

 

2. Copies of the required medical documents (no originals, no zip-, rar-, or bitmap-files)