For identification purposes we need your name, e-mail address and date of birth. In order to issue the prescription, please indicate the required medication. You can pick up your prescription in our surgery during our opening hours. Please also note the instructions for pickup below the form.
Information on the pick-up process:
According to the new General Data Protection Regulation, we are not allowed to hand out any prescriptions, x-rays, CDs, etc. without your express consent to relatives or other persons. If you wish the aforementioned documents to be collected by a relative or another person, please print and complete the consent form and sign it. The collector needs the declaration of consent, the health card of the patient and his own valid identity card for identification. The informed consent document (german only) can be found here: