Treatment Inquiry and Appointment

Contact form

Please select

Title

Last name*

First name*

Gender*

Date of birth*

Name of a legal guardian (for patients under 18 years of age):

Address

Zip code and city/town

Country*

Do you require visa assistance?

Desired date for treatment

Please indicate how we can contact you:

E-mail*

Phone (please include the international prefix):

Fax (please include the international prefix):

Important: We require up-to-date, informative medical documents in English or German to enable us to produce treatment recommendations and the cost estimate. You can attach them electronically here. (as Zip file if necessary)

File Upload

or send them by fax (+49 6221 56 33955) or E-mail

If you do not have any medical documents, please send as much detailed information about the disease as possible (diagnosis, symptoms, examination results and previous therapy):

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Heidelberg University Hospital
International Office
Im Neuenheimer Feld 400
69120 Heidelberg
Germany

phone +49 6221 56 6243
fax +49 6221 56 33955

international.office@
med.uni-heidelberg.de

Office hours
Monday through Friday:
8:00 a.m. - 5:00 p.m.
(Central European Time)

Heidelberg local time

08:10 AM

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Imprint www.klinikum.uni-heidelberg.de

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