Questionaire Medical Examination for employees

Prior to a medical examination we would like you to inform us of your medical history and present condition. You can do this by using the online form below.

*) means mandatory field

  1. Personal data
  2. History etc.
  3. Step 1
  4. Step 2
  5. Step 3
  6. Signature
  7. Closure
Personal data
Give your body height in meter with two decimals after the comma.
Give your body weight rounded in whole kilograms or one decimal after the comma
Leave blank if date is not known yet