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International Medical Services Department

Servicii medicale.
Planificarea vizitei.
Telemedicină.
Formare profesională.
Despre noi.
Contact.

+49 761 270 21310
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Breisacher Str. 86b
79106 Freiburg
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International Medical Services › Formare profesională › Training Request Form

Training Request Form

Name, Surname

Company/Hospital

Position

Country

Telephone number

Email*

Program/Department of interest

Preferred training dates

Name of the individual or organization covering your training expenses

How did you find our hospital?

internet

friends/ relatives/ previous patients

your physician

newspaper/ magazine

exhibition

social media/ forum

other**

**please, specify

I want to use encrypted E-Mail communication (registration required)*

no

yes

I have read the Privacy Policy and agree to the following Collection of Personal Data Policy¹*

yes

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¹All the terms are subject to the law of the Federal Republic of Germany. Exclusive place of jurisdiction shall be Freiburg in Breisgau, Federal Republic of Germany.

*required field

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Training Request Form

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