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Here you may send us a booking request. Our Privacy Protection Policy you find here.

Reason for appointment

Reason for appointment *

Eye check

Prevention / Control

Child Exam

Retina / Glaucoma

Macula Exam

Lid Surgery

Contact Lens

Ocular Diabetes

Medical report (Gutachten)

Vision exam for driver's license

Suggested date and time

Date *

Day Day12345678910111213141516171819202122232425262728293031

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Year Year20242025

Time *

08:00 - 10:00 hrs

10:00 - 12:00 hrs

12:00 - 16:00 hrs

16:00 - 19:00 hrs

flexible

Personal data

Mr. / Ms. * Mr. / Ms.Ms.Mr.

First Name *

Last Name *

E-mail *

Phone *

Insurance * InsuranceGesetzlichPrivat

Your message

Message *

Datenschutz *

I have read the Declaration on Privacy Protection. I declare my consent that my data will be used for the handling of my request upon sending this contact form. (Further information and guidance on revocation you find in the Declaration on Privacy Protection.)

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