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Privacy Consent Form

I have read the Privacy Policy and agree to the following Collection of Personal Data Policy*
Do you want to disclose information and/or authorize somebody to enquire about your medical treatment (family members, friend, doctor or other third party?)
These declarations of consent are given voluntarily and I may withdraw them at any time. The legality of the data processing shall remain unaffected unless it is withdrawn.

To withdraw your consent, please send a letter clearly stating this wish to the following address:

Universitätsklinikum Freiburg
International Medical Services and International Business Development (IMS) 
Breisacher Straße 86b
79110 Freiburg
Germany

Alternatively, you may withdraw your consent online via our website:
https://ims.uniklinik-freiburg.de/en/contact-us/withdrawal-of-consent.html

Universitätsklinikum Freiburg International Medical Services & International Business Development (IMS) – Stabsstelle beim Leitenden Ärztlichen Direktor
Breisacher Straße 86b
D-79110 Freiburg
Phone: +49 761 270 19300, Telefax: +49 761 270 19310
Data protection officer of the Medical Center – University of Freiburg:
UKF Datenschutz
Agnesenstr. 6-8, 79110 Freiburg

*required field