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Way of payment:* Self finance
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In addition to the above information, please send via fax, e-mail or seperate courier a current and complete Medical Report, including films (X-ray, CT Scan, MRI, Ultrasound), pathology slides and results of radiological, diagnostic and pathology studies. Please include a copy of this completed form with these materials.

The information requested above should be send to:

IHS-Germany Berlin
International Health Services
Budapester Strasse 2f
(by Intercontinental Hotel Berlin)
10787 Berlin
Germany

Tel.: 0049 30 75659011
Fax: 0049 30 75659012
Email: info@ihsgermany.com
web: www.ihsgermany.com

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