Registration

If you have decided on a health check-up , simply use our registration form or call our office at 02222-9323-21.

Registration form

Please first select the type of a health check-up. Then complete the registration form by filling in your contact data and the desired date. As soon as you have completely filled in the data, please click the “Registration” button.

Type of health check-up:*
Salutation:*
Last name:*
First name:
Street:*
Postal code:*
City:*
Telephone:*
E-mail:*
Desired date:*
Contact me:*
Comment:*

* This information is obligatory.

Please fill in the Captcha before click the "Registration" button.

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