Referrer

Thank you for referring your patient to me!

A close and good cooperation with you as a referrer is of major importance to me.
I am committed to providing you and your patients with top service. This includes: The same contact person at all times, holiday or absence replacement ensured by the practice partner, prompt service, swift appointment allocation and direct communication with yourself (consultation, surgery and discharge reports are sent to HIN by e-mail within one working day). This ensures that you are always up to date.
If you have any questions or feedback, please do not hesitate to contact me by phone or e-mail.
I kindly request you to forward any preliminary clarifications, medical documents via HIN-Mail.
Your patient will be contacted by my administrative team within one working day following receipt of the registration form.

Registration form for referrer

Last name

First name

Date of birth

Address

Phone

E-Mail

Health insurance class

Health insurance company

Urgency

Emergency (same day)

Urgent (within 2-3 days)

Elective (within 2-3 weeks)

Referring physician

Family doctor (if not referrer)

Diagnosis

Preliminary clarifications, medical documents

Upload File

Request reports

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