• Switzerland
    Medical service centre
    «Edelweiss»

  • Individually
    comfortably
    confidentially

  • To reach
    Edelweiss!
    To learn perfection!

  • To reach
    Edelweiss!
    To learn perfection!

  • Switzerland.
    Medical service centre
    «Edelweiss»

Application form for medical services in Switzerland

Information about the patient
(Country, city, street, post code)
Accompanying person:
(check-up, treatment, rehabilitation, another? What’s your trouble What are your additional wishes? (briefly))
(Maximum file size of 20MB.)
(Maximum file size of 20MB.)
The patient (the above-named person) or his legal representative provides to the medical service company Edelweiss Medservice Gmbh or to the involved specialists (translators, specialists, etc.) the power to delegate, orally or through e-mail, his/her personal and medical information in the Swiss establishments rendering medical services (to doctors, clinics, health centres, etc.). The company Edelweiss Medservice Gmbh undertakes to observe the rules of strict confidentiality during contacts with third persons.

Margins, marked out * are obligatory for filling

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