Referral form for physicians I Center for Integrative Oncology

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Advice & treatment
Our locations
- Glarus
- Lake Zurich
- Uster
- Winterthur
- Oerlikon
- Zurich
About us
Emergency
Make an appointment
For doctors
Your opinion
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English

Home › For doctors › Referrer

Patient registration

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URL
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Your contact details (referrer)
Name
First name Second name
e-mail*
Telephone
Clinic / Practice
Patient data
Name and date of birth
Last name First name Date of birth
Address
Street, No Zip code / City
Telephone
Private Business NaTel
AHV number
Making an appointment
Making an appointment
- Please offer the patient directly
- Patient registers himself
- Make an appointment via the responsible doctor
- In case of emergency (please call +41 44 448 30 00 - thank you)
- In the next 2 weeks
- Other
Other

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Registration for ZIO location
- ZIO Zurich
- ZIO Lake Zurich
- ZIO Glarus
- ZIO Winterthur
- ZIO Uster
- ZIO Oerlikon
Registration for ZIO location
- ZIO Glarus
- ZIO Lake Zurich
- ZIO Uster
- ZIO Winterthur
- ZIO Oerlikon
- ZIO Zurich
Registration for
- Consultation: assessment and treatment proposal
- Initiation / implementation of the therapy
- Psycho-oncological counseling
- Transfusions
- Complementary co-treatment
- Hyperthermia
Reason for assignment
- Main diagnosis / suspected diagnosis
- Existing findings
- Other
Main diagnosis / suspected diagnosis
Existing findings
Other
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Further diagnostics
- Can be carried out directly by the ZIO
- After consultation with the referring physician
Further diagnostics
- Can be carried out directly by the ZIO
- After consultation with the referring physician
Additional information
Concomitant diseases
Allergies
Other

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Please send findings / reports in advance or give them to the patient.
Findings
- Medical reports
- Pathology
- Imaging
- Laboratory
- Current medication list
Remarks
Brief information by telephone or e-mail after first consultation desired
- Yes
- No
Please send copies of the reports to:
Privacy policy*
- By using this form, you consent to the storage and processing of your data by this website. (mandatory field)
If you have any questions or queries, simply give us a call: +41 44 448 30 00

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Registration (PDF)

Patient Registration (DE)

Patient Registration (EN)

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