Registration
form

Online
Make an appointment

You can use the following form to suggest appointment times. Please provide at least two suggested dates. We will contact you by phone within 24 hours on weekdays.

Please note that we must first confirm your appointment request by telephone.

You can, of course, also call or write to us directly. We can then arrange a suitable appointment with you immediately.
+49 (0)641 – 944 64 64
praxis @privatarzt-giessen.de

Online appointment request form

Please enter your personal details and preferred appointment times here. Please fill out the form as completely as possible. Required fields are marked with a red asterisk*.

Your name

Date of birth

Are you already a patient with us?

Phone number

If possible, please enter a phone number and/or cell phone number where you can definitely be reached during the day.

Preferred dates

Time frame

Appointment with doctor

one date per line

Your request

Please briefly describe why you would like to make an appointment. This will help us to better prepare for your visit.

I have read and understood the privacy policy.

You can use the above inquiry form to send us your inquiry. Your data will be forwarded to us by email via our provider and deleted immediately after we have responded, provided that there are no legal obligations to retain it. Your data will not be used for any other purpose or passed on to third parties. Please note that the transmission of data is not encrypted and therefore no confidential information should be sent via the inquiry form.

Once you have submitted your appointment request, we would be delighted if you could take a look at the Registration form and bring it with you to your appointment with us, filled out as completely as possible.

Registration form

Private Medical Center for
Inner Medicine

Contact

Contact

Registration
form

Registration
form

Online
Make an appointment

Online appointment request form

If possible, please enter a phone number and/or cell phone number where you can definitely be reached during the day.

one date per line

Please briefly describe why you would like to make an appointment. This will help us to better prepare for your visit.


phone	+49 (0)641 944 64 64
mail (Praxis)	praxis @privatarzt-giessen.de
Dr. Pohl	dr.pohl @privatarzt-giessen.de
Dr. Block	dr.block @privatarzt-giessen.de
Dr. Waas	info @praxis-waas.de
fax	+49 (0)641 944 646 60

Contact

Contact

Registrationform

Registrationform

OnlineMake an appointment

Online appointment request form

If possible, please enter a phone number and/or cell phone number where you can definitely be reached during the day.

one date per line

Please briefly describe why you would like to make an appointment. This will help us to better prepare for your visit.

Registration form

Kontakt Formular

Kontakt Formular

Corona information

Registration
form

Registration
form

Online
Make an appointment