COM_TIMESLOT_ANMELDUNG_SCHNELLTEXT
{#standort_name}
{#standort_strasse} · {#standort_plz} {#standort_ort}
Your personal information
Warning: The name appears as entered on your test result, it cannot be changed later.
Fields marked with * are mandatory.
First name
*
Last Name
*
Email
*
Title
Gender
*
Please choose
Male
Female
Divers
Indefinite
Birthdate
*
ID number
(only required if information is required on the test result)
Street
*
No
*
ZIP
*
Location
*
Additional address
Telephone
*
Mobile
Business phone
Fax
Comment
I would like a QR code on my findings, for this I declare my consent to the transfer of my test results for the purpose of the Corona warning app to the server operated by the RKI. Further information on data protection can be found
HERE
.
Book now
Cancel