Kontakt
Link zu Instagram

Tel: 089 547041-0

Ersttermin planen
Telefonische Erreichbarkeit
Mo – Do 7:00 – 16:00 Uhr
Freitag 7:00 – 13:00 Uhr
Öffnungszeiten Praxisklinik
Mo, Di & Do 6:45 – 15:30 Uhr
Mittwoch 6:45 – 16:00 Uhr
Freitag 6:45 – 13:00 Uhr
Ansprechpartner Kontaktformular Rezeptbestellung online Patienten-Feedback
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Kontakt
Link zu Instagram

Tel: 089 547041-0

Ersttermin planen
Telefonische Erreichbarkeit
Mo – Do 7:00 – 16:00 Uhr
Freitag 7:00 – 13:00 Uhr
Öffnungszeiten Praxisklinik
Mo, Di & Do 6:45 – 15:30 Uhr
Mittwoch 6:45 – 16:00 Uhr
Freitag 6:45 – 13:00 Uhr
Ansprechpartner Kontaktformular Rezeptbestellung online Patienten-Feedback

Personal information for men

Please answer the following questions as completely as possible. Your information will be used solely for the purposes of your treatment. It will not be shared with third parties

Our questions for you

All questions marked with * are required fields.

Do you have any allergies?*
Do you take medication?*
Have you had an important operation in the past?*
Do you suffer from a serious illness?*
Do any of your parents, grandparents or siblings have vascular diseases (heart attack, stroke, thrombosis, dementia)?*
Do you smoke?*

Do you suffer from any of the following symptoms:

Depression?*
Memory loss?*
Weight gain or loss?*
Hair loss?*
Hot flashes?*
Difficulty sleeping?*
Loss of libido?*
Loss of energy / listlessness?*

Your MAIN ISSUE?*

General information

How did you hear about us?

Data protection notice

We would like to alert you to the fact that all data transmitted to us is stored and processed with the help of electronic data processing. The data entered in this form will be deleted after submission. We handle the information you provide with strict confidentiality and do not transfer it to any other party. Please consult our data protection notice.

Was ist die Summe aus 4 und 1?
SSL

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