Treatment request for international patients

To receive a cost estimate and check if a treatment is possible, please complete the attached contact form

1

Request

Sent your request to the IPO.

2

Cost estimate

We will forward your request to our experts in the relevant department and will send you a cost estimate for your treatment

3

Payment

Payment of the cost estimate: you can either transfer the money to our banc account or pay by credit card.

4

Appointment

The responsible department will receive your payment and contact you to arrange an appointment for your treatment as quickly as possible.

! Please note that the clinic does not offer an interpreting service (Dolmetscherservice). If reqiured or desired, you can organize and pay for an interpreting service yourself.

Treatment Request

Form of adress *

Mrs.

Mr.

Title

First name	Surname *	date of birth (format:yyyy.mm.dd) *
Phone	Mobile phone

email *

email confirmation *

Message

Which department is relevant to your diagnosis?: *

Initial diagnosis (if known)

Your request *

Consent *

I agree with the data protection statement.

* required field

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