Application for treatment

Apply now, and our highly qualified staff will quickly and professionally choose specialized clinics and physician and prepare visa invitation from the clinic.

Application processing time varies from a few hours to 2-3 working days (depending on the complexity of the inquiry). Please fill in the form and we will contact you immediately.

    Questionnaire of the patient traveling to the treatment in Germany:

    Date of birth:

    Occupation / place of work:

    Address:

    Phone*:

    E-mail*:

    Traveling document

    Citizenship:

    Name, surname as in the traveling document*:

    Serial number:

    Date of issue:

    Valid to:

    Issuing authority:

    Diagnosis

    Date of establishment of diagnosis, in the presence of complications, comorbidities and surgeries - specify:

    Main diagnosis:

    Complications:

    Comorbidities:

    The purpose of your visit:**

    Under what conditions you would like to get medical help?**

    * Obligatory fields

    ** Multiple choice is possible