Contact form

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International Medical Services - Contact form

CONTACT FORM
Prelimitary Information
We have reactivated our contact form for patient inquiries from abroad. However, due to the ongoing pandemic, some restrictions still apply.

Please note that we require the following documents in addition to the filled contact form. Before you start filling our contact form you may want to gather all relevant documents:

  • Up-to date medical reports in English or German (not older than 3 months).
  • Some inquiries require protocols of previous treatments or images (MRI,CT,...).
    (Please note that images should be provided in DICOM-Format. For the upload of your images we can send you a link to our dedicated platform)
  • A passport copy of the patient.
  • If you are not the patient or request a cost estimate, a signed release of confidentiality ist required. We provide a document for download and ask you to send it with all the other documents.


    • Download our document „Release from confidentiality“

      English/German (Pdf-file, 91,1 KB)

      Arabic/German (Pdf-file, 102,4 KB)

      Russian/German (Pdf-file, 101,6 KB)

      When choosing the documents you share with us, please keep in mind that we cannot handle documentation that is too extensive and/or outdated.
Patient Data
Gender*
You need an interpreter? (paid by the patient)*
You require visa assistance? (supporting letter for the embassy)*
Medical Information
Inquiry for our Check-Up-Programme only
Relevant diagnostics that have been performed recently (not older than 6 month)*
Patient's present mobility status*
Provide your Documents
  • Kindly click here (mailto: ims@unimedizin-mainz.de) to attach the latest medical reports in English or German (not older than 3 months) and a passport copy of the patient.

  • Alternatively you can send your documents and image files to our office:

    Universitätsmedizin Mainz
    International Medical Services
    Langenbeckstr. 1
    Geb. 301, EG, Zi. 34-36
    D-55131 Mainz
    Germany

  • When choosing the documents you share with us, please keep in mind that we cannot handle documentation that is too extensive and/or outdated.
Further Information
How did you find our Medical Center?*
Documents
Documents I provide*