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Registration Form

Fill in and submit the following registration form. We will get in touch with you soon to schedule your first appointment.

Personal Information

First name

Surname

Date of birth:

...

Street & House Nr.

Zip Code & City name

Your contact details

Email:

Mobile-Phone

Your Swiss Health Insurance Provider

Name of Health Insurance Provider:

Health Insurance card-Nr.:

Are you seeking physiotherapy for accident-related issues/pain?
NoYes - I have registered the accident with my SWISS accident insurance provider (Unfallversicherung)

In case of accident – please state the name of your Swiss accident insurance provider.

Do you have a doctors prescription (Verordnung) for physiotherapy?
YesNo - I pay for treatment myself.

Please upload your physiotherapy prescription (only possible through mobile phone)

Please briefly describe your situation or the diagnosis for which you seek treatment:

You prefer to register on your smartphone?

Simply scan the following QR-Code with your phone camera und fill & submit the form on the go.

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Return To Main Page

Back To Main Page

Sprache wählen / Choose Language:
DEUTSCH / ENGLISH

Registration Form

You prefer to register on your smartphone?

Glattpark

Öffnungszeiten

Back To Main Page

Sprache wählen / Choose Language:DEUTSCH / ENGLISH

Registration Form

You prefer to register on your smartphone?

Glattpark

Öffnungszeiten

Sprache wählen / Choose Language:
DEUTSCH / ENGLISH