Patient registration | Schulthess Klinik

Dear Patients,

For the best advice and referral, we recommend that you contact us first by telephone on +41 44 385 74 53 before registering yourself for an appointment.

Thank you.
Your Sports Medicine Team

Hand

left

right

Both sides

Finger

Thumb

Index finger

Middle finger

Ring finger

Pinky finger

Elbow

left

right

Both sides

Shoulder

left

right

Both sides

Elbow

left

right

Both sides

Foot

left

right

Both sides

Hip

Hip, left

Hip, right

Hip, both sides

Knee

Knee, left

Knee, right

Knee, both sides

Dear Patients,

thank you for registering for the assessment and treatment of your back pain. We will forward your inquiry to qualified spinal specialists (in the neurosurgery, orthopedics, neurology, rheumatology or manual medicine departments) and kindly ask you to complete the questions as fully as you can. You will be contacted as soon as possible by the respective department.

If medication is no longer alleviating your symptoms, please call the emergency hotline directly on +41 44 385 72 72.

Thank you
Your Spine Team

Spine localization

Cervical spine

Thoracic spine

Lumbar spine

Coccyx

Cervical spine

right

left

center

Thoracic spine

right

left

center

Lumbar spine

right

left

center

How long have you had your symptoms?

0 - 3 months

3 - 12 months

more that 12 months

Have you already been to a doctor/ family doctor because of your symptoms?

Yes

No

Which doctor did you see? (Name, address)

Have you already received surgical treatment for your symptoms?

Yes

No

In which year and where did you receive surgical treatment?

Existing imaging

X-ray

MRI

CT/SPECT CT

Other

None

Date X-ray

Place X-ray

Date MRI

Place MRI

Date CT/SPECT CT

Place CT/SPECT CT

Date Other

Place Other

Remarks

Please describe your condition in as much detail as possible:

How long have you had this condition?

Have you had an accident?

yes

no

Have you already seen a doctor due to this condition?

yes

no

If yes, which preliminary examinations have already been carried out?

X-ray

Date

MRI / CT

Date

Neurological examination

Date

Rheumatological clarification

Date

Have you already had an operation due to this condition?

yes

no

If so, which operations have already been performed?

Digital appointment booking

If yes, which preliminary examinations have already been carried out?