Appointment

    Your name/name of the child *

    Your email address *

    Date of birth/your child *

    Street and House number *

    ZIP Code and City *

    Phone*

    Subject

    Your message

    I agree with the Privacy Policy to.*

    This form stores your name, email and phone number only to contact you on your request. For more information, please see our current privacy policy.

    By agreeing to the current privacy policy, you confirm that the private practice Drs. Med. Elisabeth Aust-Claus/Dr. Med. Dieter Claus can receive your name, date of birth, telephone number and e-mail address and save it temporarily.

    For security reasons, ask them to enter the following characters in the adjacent field so that your request can be sent. Thank you very much.

    890572065 - Terminanfrage

    Attention: If you would like to register for ADD/ADHD-diagnosis, you can also register here directly via our questionnaire, which is available for download here:

    Of course you can also contact us directly by phone.

    For security reasons, the privacy policy must be approved in order to be able to send your request!

    * Required Field