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Contact form practice Dr Michael Singer

Is our phone 044 202 6440 busy? You may conveniently ask for your next appointment here. Your data will be handled confidentially. Fields with an asterisk (*) must be filled in in any instance.

 

Family name, given name *

Date of birth *

E-Mail *

Daytime phone *

Already our patient?

Yes   No

 If new patient: do you have a
 hospital supplement (private/semi-private) ?  Yes  No

Reason for consultation

Yearly checkup

Pregnancy

Fertility

Hormone counseling

Problems/pain

Ultrasound

Inserting coil

Other reason

Preferences

  Mon  Tue  Wed  Thu  Fri
  morning  afternoon  any

How urgent

can wait medium urgent

Remarks /
Ordering prescription

  

 

 

Please telephone or send us a fax if we have not contacted you within two working days, or if the requested prescription has not arrived within one week. Remember that we may be on vacation, and consult our substitute (according to the voice mail at +41 44 202 6440) if necessary.