Please fill out the following fields below (* are mandatory) for a nonbinding coordination request. Our team will get back to you as soon as possible.

CR za

page za

First Name*

Last Name*

Phone/Mobile

E-Mail*

Country*

Holiday Period

First Treatment Date of Holiday*

Last Treatment Date of Holiday*

other country

Destination

Country*

other country

City/Region

Coordination documents

Please submit the following documents:

Holiday Dialysis Request

General Terms and Conditions

Further Requests

Don't fill this field!

Holiday dialysis