International Medical Services - Contact form

CONTACT FORM
Prelimitary Information
  • 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.

      • 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the documents you share with us, please keep in mind that we cannot handle documentation that is too extensive and/or outdated.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the documents you share with us, please keep in mind that we cannot handle documentation that is too extensive and/or outdated.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*