Registration form for ME/CFS and Long COVID

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 *

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:

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

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.