Departments

Appointment request – private patient clinic, internal medicine

Dear Patient,

Thank you for your interest in a consultation or treatment at our department. As there are times when we may be difficult to reach by telephone, we would like to offer you the option of sending us an appointment request by e-mail using the form below.

We will contact you shortly.

Many thanks

Please bring the following documents to your appointment:

Any available recent findings or imaging (e.g. CDs) relating to your symptoms.

Title

First name

Surname

Date of birth

E-mail

Please provide your telephone number if we may call you.

Name of private health insurer

Choice of specialist clinic

For which symptoms would you like advice?

Have you already been treated in our Department of Internal Medicine?

YesNo

I have read and accept the privacy policy of the Diakoniekrankenhaus Freiburg. I agree that the data I have provided may be stored and used to process my enquiry. I understand that I can object to the use of my data at any time by e-mail to datenschutz@diak-fr.de.

Please do not send detailed health information through this form. Your details are stored solely to process your request. Privacy policy