Klinik Hirslanden Enquiry Form

Country
Contact e-mail address
Additional information (optional)
When requested you will need to send recent scans in DICOM format (a common standard for medical scans) directly to Klinik Hirslanden.  Scans may be posted on a CD or can be uploaded directly by internet and they will advise you how to do this at the appropriate time.  Please list below what scans you have available to send.
Patient name and title (e.g. Dr Robert Smith)
Condition to be treated
Contact name and title
Relation to patient
Medical condition
Scans available for submission
Date
Type
Scan
Other information regarding scans
We offer links to private scanning centres in an increasing range of countries.  These centres can assist you in obtaining recent scans and in the correct format for making enquiries for treatment or second opinions   Visit the Scanning Centres page and follow the link for your country.
Authorisation to submit an enquiry
Note: enquiries to Klinik Hirslanden through A1Med will be handled by Medilux Healthcare Ltd. (MHL).  Once discussions are commenced all communication will be between the enquirer and Klinik Hirslanden, without reference either to A1Med or MHL.
What happens next?
I am the patient or I am authorised by the patient and I hereby request A1Med to submit this enquiry to Klinik Hirslanden without cost or commitment to myself.

I understand that all clinical and financial decisions will be made by Klinik Hirslanden and that A1Med's role is confined to facilitating this initial enquiry.  I agree that neither PPM Consult Ltd. (owners of A1Med) nor MHL will not be responsible for any treatment or failure to diagnose or adequately treat any condition, whether disclosed or undisclosed.
If you have supplied sufficient information we will send your enquiry to Klinik Hirslanden and they will normally respond to you directly.  If we cannot submit your enquiry for any reason or more information is needed we will tell you by e-mail..
Patient and contact information
Please send a blank e-mail to our test service and wait for the auto-response.  If you do not receive this, check your spam filter or mail settings.
Please do not send scans or medical histories to us.  We are not doctors and we cannot review or comment upon individual cases.  These will be called for by Klinik Hirslanden if and when required.
Scans and medical records
Communications
Internet and e-mail are used to ensure that enquiries are handled rapidly and efficiently, however these are not secure media and we shall not be responsible for information which may be accessed without authorisation or fails to arrive.  By contacting us in this way patients or doctors indicate their agreement with us that the avoidance of unnecessary delay for patients with serious medical conditions outweighs any such small risks.
Spam filters
www.a1med.co.uk
A1Med is an information and marketing service from PPM Consult Ltd.
© PPM Consult Ltd . 2006-2012. All rights reserved                        
Please type these characters  into the box.  Letters must be typed in upper or lower case as you see them.
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Simply send a blank e-mail to:
Did you check your e-mail system?  E-mails from unfamiliar sources may be blocked by your spam filter.  If you do not receive a reply from us or your chosen centre, check your spam or junk mail box.  Use our automated e-mail checker at any time to ensure that messages can reach you. We cannot reply if our e-mails are blocked!
You cannot submit attachments with this form but please state the date and nature of any medical reports that you have available.  If you wish to submit these immediately you do not have to use this form.
You can submit an enquiry by e-mail to:
Important note to all patients
A1Med features selected clinics and certain specialities within individual hospitals, where we believe the standards of care and medical equipment to be exceptional.  We provide you with general information and details of how to make contact with the centre.  This service is provided in cooperation with Medilux Healthcare Ltd.
We may pass your enquiry to the relevant clinic or department but we cannot advise or enter into correspondence about individual cases and we do not arrange or facilitate treatments  All the centres that we feature have international patient enquiry services which will be pleased to answer your questions about services and costs.