Registration form
Personal details
First name
Surname
Date of birth:
...
Street and house number
Zip code & city
Your contact details
Email:
Mobile phone number
Your health insurance company
Name of the health insurance company:
Health insurance card number:
Are your complaints the result of an accident? NOYES - I have reported the case to my accident insurance company
If accident: Please specify accident insurance.
Do you have a doctor's prescription for physiotherapy? YESNO - I pay privately.
Upload your prescription here (only possible on mobile)
Complaint/case description:
Scan the QR code with your cell phone camera and fill out the registration form on the go.