Your Title*
Mr.Mrs.Ms.

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Last name*

 
Date of Birth - Format: DD/MM/YYYY *(required)

Your City*

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Your Mobile number with country code*

Your Email*

 
For whom?*
MyselfRelativeFriendOther

 
For how long you like to book*
Don't know yet - TBDEntire time

 
Which transfer services you like to book?*

NoneAirport transfersDaily transfers for my appointments onlyDaily transfers to the clinic for companionsDaily transfers for shopping etc.Sightseeing toursAny other not listed here

 
Class of VIP transfer service*
Mercedes Benz S class/Audi A8/BMW 7 seriesBentleyRolls RoyceMaybachVIP Van

 
Choose the country you want to get the VIP service*
GermanyAustriaCzech RepublicSwitzerland

 
How you would like to cover the treatment cost?:*
Self-payingEmbassy / MOH

 
Explain your medical problem / medical needs:

 
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