Your Title
Mr.MrsMs.

First name*

Last name*

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

Your City*

Your Mobile*

Your Email*

Choose the country you're from*:
AlbaniaAlgeriaAndorraAngolaAntigua & BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia & HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChileChinaColombiaComorosCongoCongo Democratic RepublicCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEast TimorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaFijiFinlandFranceGambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea NorthKorea SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalThe NetherlandsNew ZealandNicaraguaNorwayOmanPakistanPalauPalestinaPanamaPapua New GuineaParaguayPeruThe PhilippinesPolandPortugalQatarRomaniaRussiaRwandaSt. Kitts & NevisSt. LuciaSt. Vincent & The GrenadinesSamoaSan MarinoSao Tome & PrincipeSaudi ArabiaSerbiaSeychellesSingaporeSlovakiaSloveniaSolomon IslandsSouth AfricaSpainSri LankaSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTunisiaTurkeyTurkmenistanUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

 
For whom?*
MyselfRelativeFriendOther

 
Which medical department?*
Aesthetic SurgeryAddiction/Drug RehabilitationCardiologyGeneral SurgeryGynecologyInner MedicineIVF TreatmentMedical CheckupOrthopedics (Knee, Hip, Shoulder)Plastic SurgeryRehabilitation OrthopedicsRehabilitation NeurologySpine SurgeryStem Cell Therapy OrthopedicsStem Cell Treatment NeurologyStem Cell ChildrenBrain Stroke RecoveryTrauma SurgeryVascular SurgeryUrology- Not Sure -

 
What do you like to book?*
Booking AppointmentRequesting Cost EstimateOrdering Medical Second Opinion (Cost starts from 899,00 Euro)

 
Choose the country of treatment*
GermanyAustriaCzech RepublicSwitzerlandSerbia

 
How you would like to cover the treatment cost?:*
Self-paying (No insurance)International Health InsuranceEmbassy / MOHGerman National Health Insurance

 
Explain your medical problem / needs:

 
Attach files here:
Max. upload per file 3MB per file (jpg, jpeg, doc, docx, pdf) only
 

I agree to the Privacy Policy and Data Usage Policy of GermanyHealth*.