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Surgery arrangement order

Note: This English version is a convenience translation. In case of doubt, the German version of this page is legally binding.

In accordance with the Terms and Conditions I hereby instruct CZ-Wellmed to reserve a surgery date for me, on a binding basis, at the clinic named below.

How the surgery arrangement order works

With the order, you instruct CZ-Wellmed to arrange and reserve your surgery date at the chosen clinic. You conclude the treatment contract with the clinic or the doctor. A deposit is required for confirmation; we will tell you the amount and deadlines with the appointment confirmation (usually within one working day). You usually pay the remaining amount directly at the clinic.

Based on your photos, you receive a binding quote tailored to your needs, with a fixed price. All prices stated are from-prices; the fixed price is recorded in your appointment and price confirmation. Photos do not replace an on-site consultation: if your information differs from the findings in the photos, the price may change on site.

  1. Consultation and appointment arrangement with us
  2. Complete and submit the form
  3. Confirmation of appointment and price, transfer the deposit
  4. Receive preparation documents

Conditions: Terms and conditions, withdrawal information, privacy policy.

Order as a PDF to print

Your contact details

Title

* Required fields

Travel / hotel reservation

I will be travelling

The night before surgery, I/we will stay in a

Please reserve for me/us for the night before surgery a

Please book for my companion(s) during my stay at the clinic a

Pick-up and return journey (chargeable)

Arrival: transfer from the

Departure: transfer to the

Your surgery details

Please select at least one clinic.

Laboratory / internal medicine examination

Terms and conditions and confirmation option

I would like to receive the appointment and price confirmation by

I have read and accepted the Terms and conditions, privacy notice and the right of withdrawal on the page. As proof, we store the time, the version of the texts and a shortened, non-reversible check value of your IP address (see privacy policy).

Option to withdraw

You can withdraw from your contract by e-mail. We will confirm receipt of your withdrawal by e-mail. You will find the full information at withdrawal information.

Withdraw from contractAlternatively by e-mail

When withdrawing by e-mail, a prepared message opens in your e-mail programme.

Confirmations and consents *

Please send us photos via the secure photo upload, not by e-mail or WhatsApp.