Reference doctor: prescription

With a prescription to Upendo Health GmBH in case of availability on our part we would be happy to offer therapy places for your patients within the team and arrange an appointment for an initial consultation with the therapist as soon as possible. Please complete the form below.

Alternatively, you can send us the order via email: mail upendo@hin.ch

Please find here the template for the medical prescription

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Patient information

Fields marked with * are mandatory. All information is transmitted in encrypted form.

Name*
Surname*
Date of birth
Phone number*
E-mail
Therapy language (preferred)
Problem description, comments

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Referral medical doctor contact information

Fields marked with * are mandatory. All information is transmitted in encrypted form.

Name and title*
Surname*
Practice, hospital, clinic*
Phone number medical doctor*
Email*
In case of acute suicidal tendencies: please call the emergency number 144 or the doctor's telephone number: 0800 33 66 55

Mailupendo@hin.ch

Phone+41 78 263 36 67

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