* Permission holder: * Contact person: * Contact person’s email address: * Phone number: * Date and time/time period of filming: * Filming location(s): * I have read and understood the disclosure

: PD Dr. Kambiz Afshar E-mail: afshar.kambiz @ mh-hannover.de Address Hannover Medical School Institute ofGeneral Medicine and Palliative Medicine Carl-Neuberg-Strasse 1 30625 Hanover

regulations . Please be sure to use your MHH student e-mail address (example: max.mustermann@stud.mh-hannover.de). After registration you will receive an e-mail. This e-mail will ask you to confirm

Attending physician in the outpatient clinic (if known): Email address: * Your message: * I have taken note of the following information obligations, which fully inform me about the use of the data

Medicine Phone: +49 511 532-2744 Allgemeinmedizin @ mh-hannover.de Address Hannover Medical School Institute ofGeneral Medicine and Palliative Medicine Carl-Neuberg-Strasse 1 30625 Hanover

Franziska Herbst Contact: E-mail: allgemeinmedizin @ mh-hannover.de Address: Association for the Promotion of the Institute ofGeneral Medicine and Palliative Medicine of the MHH e.V. Carl-Neuberg-Str. 1

the head psychotherapist Sarina Höpfner via the following e-mail address: Psychiatrie.psychologie-praktikum @ mh-hannover.de Please enclose the following documents: Cover letter (including details of the

Ultraschall-Pränatalmedizin: Mo - Do 8 -15.30, Fr 8 -14 Uhr 0511/532-9581 Address: Medizinische Hochschule Hannover Klinik für Frauenheilkunde und Geburtshilfe Pränatalmedizin (MVZ) Univ. Prof. Dr. C. von Kaisenberg

Street, house number: Zip code: Place: Telephone number: Email address: I am a: Please select patient Relative a visitor Caregiver Referrer Nature of your request: General request Suggestion Complaint

outpatient clinic Last name: * First name: * Date of birth: e-mail address: * Callback number: * Your request: * Prescription request Appointment request Request for findings Other questions You can leave