Reservation request

For the provisional reservation of a dialysis center please fill out the following form and click on Submit. We will get back in touch with you.

On the MS Europa

Details and booking:

Your reservation request

Salutation Please select a title.

First name* Please enter a valid first name.

Last name* Please enter a valid last name.

Street* Please enter a valid street.

No.* Please enter a valid number.

Zip* Please enter a valid zip code.

City* Please enter a valid city.

Country* Please enter a valid country.

Phone* Please enter a valid phone number.

E-Mail* Please enter a valid E-Mail address.

Insurance Coverage* Please indicate a health insurance company.

Date of birth (dd.mm.jjjj)* Please enter a valid birthday.

Further information Please enter further information

Dr. med. Peter Rittich, Mittelweg 110 B, 20149 Hamburg, Deutschland