Contact Form

International Treatment Inquiry | Embassy, company, insurance

Should you wish a medical examination or treatment, please provide us with this form completed in English and the necessary medical Report.

» Form in German / Formular in deutscher Sprache

Klinikum Stuttgart - please fill out form:

Patient data
Visa assistance

Providing the information requested in the following two fields (Passport number and copy of the passport) is voluntary. However, as treatment can not be carried out at Klinikum Stuttgart without the data asked for in those two fields, we have marked them as mandatory. Reason is, that this information enables accurate identification and thus serves patient safety.

Contact data of requestor
Medical Information
Please indicate further relevant diagnoses
Please indicate your (the Patient's) mobility status*
How did you learn about Klinikum Stuttgart?
Medical Reports
Total size of documents may not exceed 50 MB.
DICOM
Please select
Please confirm*
You have problems to submit this form? Please check previous steps for missing mandatory information.

Klinikum Stuttgart

International Patients
Kriegsbergstrasse 60
70174 Stuttgart
Germany

Phone: +49 711 278-32060
Telefax: +49 711 278-56194
E-Mail: PM-i@klinikum-stuttgart.de

Local time in Germany:

Mandatory fields

The fields indicated with an asterisk (*) are required to complete this transaction.