Contact form CED

Please enable JavaScript in your browser to complete this form.

Fields marked with * are mandatory

Symptoms

What acute symptoms do you have? *

Do you have a known chronic inflammatory bowel disease? *

Have you been treated for inflammatory bowel disease in the past? *

What medication have you been treated with (if known)

Have you had a colonoscopy in the past? *

What year was your last colonoscopy?

Personal details

Salutation *

Name *

First name

Last name

Date of birth *

E-mail address *

Phone number *

Your message to us

Insurance

Choose an insurance *

Data protection

You can find all information on this in our privacy policy.

Data protection *

Robert-Koch-Str. 70c | 77815 Bühl
Phone: +49 7223 - 28 16 30
Fax: +49 7223 - 28 16 322
E-mail: info@innermed.de

Monday - Friday: 08:00 - 16:00

Emergency consultation
Monday - Friday: 11:00 - 13:00
Saturday: 09:00 - 12:00

Scroll to Top