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International Medical Services & Business Development

Official Site of the Medical Center – University of Freiburg

Second Opinion Request Form

Second-Opinion Request Form

Persönliche Daten (E)
Gender*
Have you already been treated in our medical center?*
You are interested in*
How did you find our hospital?
I want to use encrypted E-Mail communication (registration required)*
Rules and prices*
I have read the Privacy Policy*
Collection of Personal Data*

I agree that personal data may be made available to the following parties under stringent security measures. I have been informed that I may withdraw my consent at any time.

I have been informed that within the framework of my treatment at the Medical Center – University of Freiburg my personal data are collected, stored and, if need be, forwarded for medical, administrational and invoicing purposes to ensure the best possible planning and procedure of my treatment. A CRM (customer relationship management) system is applied. Data transmission follows stringent security measures and is, if possible, encrypted. If my enquiry/ treatment demands, data can be transmitted to any of the following:

  • German embassies and consulates
  • authorities in Freiburg (such as civil registry office, immigrations office)
  • interpreters & translation services
  • ambulance drivers in emergencies (also air ambulance)
  • hotels
  • courier services
  • wheelchair services at airports
  • drivers / taxi drivers
  • other authorities such as customs or the police 
  • pharmacies 
  • financial clearing centers
  • rehabilitation clinics 
  • medically specialised shops such as medical supply stores, opticians, hearing aid acousticians 
  • external physiotherapists 
  • additional medical facilities (e.g. health care centers)
  • funeral services

This declaration of consent is given voluntarily and I may withdraw it at any time. The legality of the data processing shall remain unaffected unless it is withdrawn.

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 The legality of the data processing shall remain unaffected unless it is withdrawn.

Please note: according to the German law, your physician must be present during your online-consultation

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