Skip to content
0231 / 141 237kontakt@diabeteszentrum-doc.deKampstraße 45, 44137 Dortmund
Diabeteszentrum Dortmund
Book an appointmentAppointment

Patient service

Medical history forms

Fill in your medical history form before your appointment – it saves time at reception and avoids unnecessary paper.

Medical history form

  • General medical history form

    Visiting our practice for the first time? Please fill in the form before your appointment.

    Fill in online
    Fill in the form

  • Gestational diabetes form

    Is gestational diabetes suspected in your case? Please use this special questionnaire.

    Fill in online
    Fill in the form

  • Diabetes medical history form

    Visiting our practice for the first time? Please fill in the diabetes-specific form before your appointment.

    Fill in online
    Fill in the form

  • Diabetes anamnesis

    In order to care for you optimally with regard to diabetes therapy, we need some important information from you.

    English
    Fill in form

Take the next step

Ready for your next appointment at the diabetes centre?

Professional advice, state-of-the-art therapies and a caring team are waiting for you. Arrange your appointment – in person or conveniently online.

Book onlineOnline courses

Reachable by phone

0231 / 141 237

Mon, Tue, Thu 08:00–12:00 & 13:30–17:00

Wed 08:00–12:00 · Fri 08:00–12:30

Write an email