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Get an appointment

Is our phone line busy again? You can ask for your next appointment by filling in this form. Your data will be handled confidentially (see Copyright).

First & last name
Date of birth
E-Mail
Private/mobile phone
Work phone
Fax
Already our patient?	Yes No
	If not our patient yet: Do you have an insurance for private hospitals ('Privat' / 'Halbprivat')? Yes No
Appointment for	Annual checkup	Pregnancy
	Infertility	Hormones
	Pain/cycle	Ultrasound
	IUD	Other reasons
Preferences	Mon Tue Wed Thu Fri Morning Afternoon doesn't matter
Urgency	can wait medium urgent
Remarks

Please phone us or send a fax, if we have not contacted you within two working days after sending your mail. Please note that there can be a delay due to vacations, and consult our substitute or your family doctor in case of urgency.