This page has been machine-translated from German. The German version is binding. Go to the German version

Request a follow-up referral

For another referral to a specialist practice where you are already being treated.

Please fill in all fields that are not marked as ‘optional’.

Part 1 of 3 Your details

Please write it exactly as it appears on your health insurance card.

First name

Last name

Date of birth

Day.Month.Year, for example 07.03.1952

Phone number for queries

With the area code – ideally a number on which you can be reached during the day.

How are you insured?

statutory health insurance (gesetzlich) private health insurance (privat)

Part 2 of 3 Your referral

Specialty

For example orthopaedics or ophthalmology. Suggestions appear as you type.

Reason or previous findings

A few words are enough, for example ‘knee joint check-up’.

Previously referred by (if known)

Name of the practice that issued the last referral.

Part 3 of 3 How would you like to receive the referral?

electronically, if possible on paper – I will collect it at the practice At the reception desk, during opening hours.

Not for emergencies. We do not read online requests straight away.

We only use your information to process your request. Privacy notice (opens a new window)

Please check your details