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New Patients

Registration Form

Personal Information

I am a new patient

In all patients affected by our firm of Saint-Aubin (Neuchâtel), responsible for our first consultations will be unable to work following surgery and will be back in January 2017! If you would nevertheless make an appointment quickly, we have the opportunity to meet you at our office in Lausanne or you still have the opportunity to do an online consultation on our website. Thank you for your understanding and look forward to meeting you!

Fill out the form below and make your own appointment online
Or just call us at 076.207.7000

First Name *

Middle Name

Last Name *

Is patient a minor?

Yes No

Email ID *

Mobile * +

Country

Zip

Address

City

State

Date of Birth *

Sex *

Referred By

Do you have a brother or sister who has already been processed in our office?

Language of preference

Photograph of the patient (passport photo) - optional

Which office location do you prefer :*

Select Doctor*

Terms & Condition* Click Here

The information provided is accurate and precise and I accept the terms and conditions of this website

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