Ein Unternehmen der RHÖN-KLINIKUM AG

Treatment Enquiry Form

Please complete this form for our international treatment enquiry:


Patient Data

Date of Birth (DD/MM/YYYY)


Medical Information


Medical Records

Once we have evaluated your data, we will send you a link where you can upload you medical records and further data we might ask for. The information in this form as well as the uploaded data is encrypted and no unauthorised  person outside our hospital will be able to access this information.