Our forms

• Contact form

  General registration, including for chronic illness, with the exception of ME/CFS and Long COVID.
  Also for questions to the clinic.

  Go to the contact form

  The registration form for ME/CFS and Long COVID is further down this page.

• Personal details

  You would normally complete this form at the SGK reception on your first visit. It covers your personal details, insurance details and the clinic’s billing rules.

  You can conveniently complete it here in advance or, alternatively, at your first visit to SGK.

  Our tip: it is best to complete the form online straight away. This saves you time on arrival and allows us to prepare your visit as well as possible.

  Optional · 5 minutes

  Enter personal details

• Health Questionnaire

  78 questions on nutrition and digestion, hormonal balance, detoxification, elimination and immune defence. You can add a comment to each question.

  Optional · 10–15 minutes

  Complete the questionnaire

• Submit your records

  Upload doctors’ reports, laboratory results and images here, as PDF or JPG, if possible one week before your appointment.

  If you would prefer to send your records later, we will still put you down for a consultation. To do so, choose the corresponding option in the registration form.

  Optional

  Upload your records

• Consent to AI-Assisted Analysis of Medical Records

  Where records are extensive, we can analyse selected documents using artificial intelligence. For this we need your express consent.

  Optional · 1 minute

  Go to the consent form

• Assessments to date

  What has already been assessed in your case, and what has not? You answer from memory and can leave out areas.

  Required · 15–20 minutes

  Complete the questionnaire

• Registration form for ME/CFS and Long COVID

  The registration form for the specialist consultation. The more complete your details, the better we can prepare your case and plan the appropriate medical care.

  Required · 5 minutes

  Open the formClose the form

  Fields marked * are required so that we can reply.

  Please leave this field empty

  First name / surname *

  Date of birth dd.mm.yyyy (please keep to this format, separated by full stops)

  Street + house number

  Postcode + town

  Telephone

  Email address *

  Waiting list for Dr. med. P. Rejmer

  Please put me on the waiting list (waiting time > 1 year). I agree to consult other experts at SGK.

  Main concern (multiple selection)

  Diagnostic assessment Second opinion Treatment Long COVID Post-vac ME/CFS CFS POTS/dysautonomia MCAS Other illness Insurance / disability insurance (IV) questions

  Have you already been diagnosed with ME/CFS?

  Yes No Suspected diagnosis

  Onset of illness

  less than 3 months 3–6 months 6–12 months 1–3 years more than 3 years

  Onset

  sudden within weeks gradual

  Possible trigger

  COVID other infection vaccination operation accident pregnancy physical overexertion psychological stress environmental exposure other unknown

  Consultation possible

  normal accompanying person short appointment breaks needed quiet room telemedicine Telephone

  Red flags

  fainting new neurological deficits chest pain severe shortness of breath high fever weight loss unable to take fluids acute mental health crisis none of these

  In the event of acute or life-threatening complaints, please call the emergency number (144) or go to an emergency department. This form is not intended for emergency care.

  Where needed, our cause-oriented approach to treatment includes additional diagnostic and therapeutic measures that are not always covered by basic or supplementary insurance. To help us assess your options, we ask you for the following information:

  Private services...

  are not a problem for me. are possible within certain limits. are not possible.

  Number of doctors and institutions consulted so far

  So far only my GP 2-5 6-10 10+

  Is there anything else you would like to tell us about your illness?

  My preferred means of contact

  Telephone Email No preference

  Files and reports

  Will be sent in a separate email. I would like to wait until the consultation.

  Please check your details briefly once more before sending. Complete information makes medical triage considerably easier for us and helps to prepare your consultation as well as possible.

  Send

  Your details go exclusively to Seegarten Klinik. For more information, see our Privacy Policy.

Additionally

• Canadian criteria and Bell score

  Questions on the Canadian Consensus Criteria and on severity according to Bell, with immediate evaluation. It is not a diagnosis.

  Required · 5–10 minutes

  Complete the questionnaire

• Treatments to date

  Which medicines and treatments have you received so far for ME/CFS or Long COVID, and what effect did they have? You select only what you have used.

  Required · 5–10 minutes

  Complete the questionnaire

• 10-minute standing test

  You measure blood pressure and pulse at home, first lying down, then standing for ten minutes, and enter the values. Instructions and immediate evaluation are included. You need a blood pressure monitor and a second person.

  Optional · 30 minutes

  Go to the instructions and record sheet

Thank you for your cooperation. It helps us to give you the best possible medical support. We look forward to accompanying you on your way to better health.