Forms

Personal details

We would like to welcome you warmly to Seegarten Klinik and ask you to complete this form and to take note of the information further down.

Fields marked are required so that we can match your details to your records.

For all women: if you were previously with us under a different name.

The number on your insurance card; it begins with 8075.

How did you become aware of us?

Billing rules

The state supervisory authority for health insurers, SanteSuisse, requires us, in line with the Health Insurance Act (KVG), to bill as follows:

Health insurer

  • General practice, emergency medicine
  • Specialists such as endocrinology, orthopaedics, diabetology, surgery

Health insurer + private

  • Treatment of chronic illness and impaired well-being
  • Consultation via the health insurer up to the time limit under Tardoc. Anything beyond that must be billed privately.
  • Basic laboratory tests via the health insurer; special laboratory tests and special treatments privately, after information on the costs.

Purely private service

  • Health check-up, performance optimisation, Blood Tuning, prevention, longevity
  • Treatment by naturopathic practitioners
  • Holistic consultations, assessments and treatments, environmental medicine
  • Infusion medicine, iron infusions without cost approval from the health insurer
  • Nutritional supplements
  • International patients

Patient information

  • The information I have given is truthful and was provided voluntarily.
  • I personally bear the risk that the health insurers do not reimburse.
  • SGK may engage external institutions for invoicing and debt collection.
  • SGK may bill insurers directly.
  • I agree to the data protection provisions in the “Declaration of Consent”. Read the Declaration of Consent
  • Private invoices are sent directly to the patient.
  • No VVG invoices are issued for private services (laboratory tests, assessments, therapy, infusions).
  • Advance payment may be required for private services.
  • Affiliated physicians act on their own responsibility. The treatment contract is hereby concluded with them personally.
  • The digitisation of medical records may be billed privately.
  • In the event of an unexcused failure to attend or a cancellation at short notice (<24h), the expected revenue may be billed as a non-mandatory service, unless otherwise compensated.
  • If you have questions or anything is unclear about the billing of services, please speak to us.

I hereby confirm that I have understood and accepted these rules.

Sign with your finger, a stylus or the mouse. If you do not sign here, we will give you the printout to sign at your first visit.

Your signature

What happens to your details is explained in the Privacy Policy.