Attention: The appointment for consultation cannot take place without a completed form. If you have difficulty filling it out, please arrive 30 minutes early for your appointment so that you can fill out the medical history on the spot.

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Dear Patient,
Dear patient,

in order to advise you well and to assist you optimally in all matters of health, we need a lot of information. Please fill out this questionnaire carefully, it contains many important questions and you may spend up to 20 minutes filling it out. Please take this time for your health.

All your health data will be processed under the strictest data protection conditions. We thank you for your trust and look forward to welcoming you to the SeegartenKlinik.

Data protection is very important to us, therefore medical and personal data is only sent in encrypted form. For additional protection, we ask you not to enter any data that can be traced back to you. The patient code allows us to assign the sent data to your file.
Example: 95
Example: 175