Appointment Request

Appointment enquiries for endoscopic examinations, ultrasound scans and functional diagnostics

If you would like an appointment for an examination, please send us this completed online form. You will be contacted within the next 5 working days, or you will receive an appointment confirmation (preferably by email). This allows us to reliably schedule an appointment for you.

Alternatively, you can send us an email at endoskopie@ukaachen.de, or you can print out this form, fill it out, and send it by fax to 0241 80-82559.

Important:

If you have acute symptoms, please do not use this request form. In such urgent cases, please call us at 0241 80-80863, or, in the case of acute and more severe symptoms, come to our emergency department.

Further information on the examinations and preparatory measures can be found  here. 

 

Appointment Request

First screening/repeat screening
Referral Form
Do you have a current referral form? (Without a referral and a specific question, we unfortunately cannot assist you. It is therefore important that you bring a referral to your appointment. The referral form also contains important information to ensure you receive the examination that is right for you.)

Diagnosis
Referral Order
Referring Physician
Which physician is referring you to us?
Examination
Which examination is planned according to the referral (or according to your own assessment)? (This will be reviewed again by us.) (Multiple selection possible)
Ultraschall
Endoscopy
Endosonography
Proctological Examinations
Functional Examination
Your Contact Details
Appointment