Contact Form

Please take notice of our data privacy information

Proceed to contact form          Read data privacy information (PDF 148,5 KB)
CONTACT FORM
Prelimitary Information

Please note that we require the following documents in addition to the filled contact form. Kindly understand that we cannot process requests if relevant documents are missing. Before you start filling our contact form we recommend that you collect 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 yourself, but are requesting for someone else, a signed release of confidentiality ist required. We provide the document here for download and ask you to send it with all the other documents.


      • Download our document „Release from confidentiality“

      English/German (PDF 91,1 KB)

      Arabic/German (PDF 102,4 KB)

      Russian/German (PDF 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the documents you share with us, please keep in mind that we cannot handle documentation that is too extensive and/or outdated.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
Medical Information
Provide your Documents
  • Kindly use (mailto: ims@unimedizin-mainz.de) to attach the latest medical reports in English or German (not older than 3 months) and the necessary documents named above.

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

    Universitätsmedizin Mainz
    International Medical Services
    Langenbeckstr. 1
    Geb. 301, EG, Zi. 0.034- 0.035
    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the documents you share with us, please keep in mind that we cannot handle documentation that is too extensive and/or outdated.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
Documents
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