Insured as (mandatory field)
Privately insured / self-payerLegally insured

Your name (required)

Your e-mail address (required)

Subject (Mandatory field)

Your telephone or mobile number
(so that we can quickly make an appointment for you by telephone)

desired date

Department / Doctor

Your message to us

Please enter the letter combination in the input field below:

Please leave this field blank.
Please leave this field blank.

Here you will find our privacy policy. I consent to my details being used to contact me and process my enquiry. I can revoke my consent for the future at any time by sending an email to info@medizinicum.de.