Current Diagnosis
Referring doctor
Confirmation

Digital referral

Diagnosis

Treatment is due to

Illness

Accident

Department

Dear Referrers, 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

Diagnosis

Patient details

male

female

First Name

Surname

Date of birth

Street, no.

Postcode

Location

Phone

E-mail

Health insurance provider

Health insurance card no.

OASI no.

Insurance status

General

Semi-private

Private

Flex