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First name

Surname

Street and house number

City

POSTCODE

Country

Telephone

Birthday

Birth

Your health insurance

Health insurance number

Insured person number

GTC

General Terms and Conditions * The service recipient confirms that the information provided is correct. The service recipient agrees to the content of this agreement and the general terms and conditions of the midwife. A copy of all information will be sent by e-mail.

Data protection

Data protection and confidentiality * As part of our service, personal data, social status and the medical data of the service recipient and the (born/unborn) children required for the treatment are collected, stored and passed on to third parties within the scope of the intended purpose in compliance with the relevant data protection regulations. The service recipient consents to the forwarding of billing-relevant data to her health insurance company and to the midwife's billing software. In the event of substitution by another midwife, the midwife will provide the continuing care centre with findings and data required for the co-treatment or further treatment of mother and child. The beneficiary also agrees to this.

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