Registration

Registration Form

To offer you a therapy spot at our practice, we require certain information in advance. We kindly ask you to complete the following registration form. A detailed description of your symptoms and areas of concern is particularly important to us. Once you have submitted your registration, you will be placed on a waiting list. As soon as a therapy spot becomes available, we will contact you promptly to discuss the next steps for your therapy. Thank you for your effort and patience!

Name(s)

Surname

Gender

Date of birth

Street name, no

Postal code

Place

E-mail

Phone

Profession

Billing method

AHV number

Health insurance

Insurance card number

Insurance model

Reason for registration/symptoms

Terms and Conditions

I confirm that I have read and accept the information on pricing and conditions, particularly the deadlines for rescheduling and cancellations.

Registration

Registration

Registration Form

Contact

Memberships

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