Prescription request

To use this service you need to register your health insurance details with us. You need to visit the practice in person for this to be done. State health insured patients also need to present their chip card at the beginning of every new quarter and pay the practice fee.

Your prescription can be collected from the next working day onwards. This Service does not mean that we will comply with every prescription request. After consulting with you, some prescriptions could be cancelled or amended.

Your details
First name*
Surname*
Telephone*
Mobile
Email*

Your prescription request
Quantity*
Medicine*
* These are compulsory fields.

Your message:

Please enter the following code into the input field:
Sicherheitscode


We would like to point out to you that the information in this form is transmitted as an unencrypted email and could possibly be seen by a third party. We are therefore unable to guarantee complete confidentiality of data transmission. The personal data which we obtain from you is used exclusively to provide the services you have requested. We do not pass on your details to any third party.