Treatment Request & Booking

To provide you with the optimum treatment plan and to book your appointment, it is essential to receive your inquiry as detailed as possible. This will also serve as a pre-assessment review by our physicians. Filling the form requires that you submit relevant data and upload, if necessary, medical documents. Kindly note that all data must be up to date. If any additional data is required, we shall contact you via email.

About the process
We normally require about five working days to provide a treatment offer and the cost estimate, provided that we have all the necessary information. If any additional data is required, we shall contact you via email and that might delay our final offer.We will do our best to arrange an appointment on a date that is convenient for you, so please indicate your availability, considering your condition and the journey ahead. Once you are given an offer, you must confirm it and proceed with paying the cost. Your treatment will then be confirmed. For questions regarding your cost estimate and/or treatment plan please contact us.

TREATMENT FORM

Personal Information
Medical Data
Medical Reports & Images
Please upload here medical image data, e.g. MRI/CT
Accepted formats: PDF, JPG, TIFF, DOC und DOCX

Treatment Request & Booking