Appointments for surgery
   
 

Your inquiry for an appointment is received by
Mrs. Petra Flechtner and Mrs. Carola Urlinger.

All data is handled strictely confidentially. Transmission to third party is excluded.

In order to process your inquiry correctly, please fill in all lines marked with a *
Regards your OGP-team.
 

   
  Your Data :
   
Title*:
Prename*:
Name*:
Date of Birth*: . .
Street:
Postal code/City*:
Nation:
e-Mail*:
Telephone*:
Telefax:
   
 
  German National Health Care Coverage:
Please fill in your German national health insurance (if applicale):
   
  Additional private insurance for in-patient treatment?
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Private insurance:
   
 
   
   
Please select a doctor:
   
 
   
Have you been treated at our center before?
   
 

Please give your diagnosis, if you know to you: