Appointment form

Would you like to be examined and advised?
We are glad to be here for you!

✔ Yes, I would like to arrange an examination and consultation at the Centre for Preventive and Sports Medicine at TU Munich.
Mandatory field Title*
Mandatory field Name*
Mandatory field Surname*
Mandatory field Date of birth*
Mandatory field House number / name, street*
Mandatory field Postcode*
Mandatory field Country*
Mandatory field Telephone number*
Availability
Mandatory field Email*
Choice of location:
	North West (O₂ Tower Munich) Georg-Brauchle-Ring 56 (Campus C), 80992 Munich Central (Klinikum Rechts der Isar) Ismaninger Straße 22, 81675 Munich South West (Zentrum für Kardiologie at Klinikum Starnberg) Oßwaldstraße 1, 82319 Starnberg
Please click (you can select more than one):
	I want to find out my health status I have been sent for a health check by my company I need a lactate test I need a cardiopulmonary exercise test I need acupuncture/chirotherapy/osteopathy I need nutritional advice I need a diving fitness examination I need an appointment at the high-altitude medicine outpatient clinic
Would you like to request a specific doctor? (Requests cannot always be guaranteed)
Preferred doctor
I would also like to provide the following information:
Other
	6 + 7

Any information will be treated confidentially and only used for internal purposes. You can find detailed information about data protection in the legal notice.