International Inquiry Portal – Transfer of Patient Data

Dear patient,

we would like to thank you for your inquiry and the transmission of your data.

Documents in German and English are accepted.

The assessment of your inquiry includes the medical analysis of all provided medical documents (CT, MRI, PET, X-ray, angiography etc.), the neurophysiological documents (EEG, EMG etc.) and the final assessment and recommendation.

The evaluation as well as the preparation of the professional statement including the medical recommendation is subject to a prior fee of EUR*300,00. The answer to your inquiry and the receipt of the fee will be made on behalf of Prof. Dr. Dr. Madjid Samii.

Once you have entered your information, you will receive an email requesting you to pay the amount of EUR*300.

If you do not consent, you can go back to the homepage here.

*This is a required field in the form, please fill out.

Patient first name*

Patient family name*

DOB*

Gender*

Citizenship*

Curent residence*

Patient email address*

Contact person

Contact person given name

Contact person last name

Contact person email address

We require the following medical information:

  • MRI and/or CT images on a CD
  • Complete, current medical finding report:
    • Neurosurgical findings
    • Physician letters
    • Surgery reports
    • Evaluation of the neurological state with state of consciousness, Cardiopulmonary state, statement of a possibly existing comatose state

Documents



add file

Graphic formats:

Text formats:

Compressed files:

Dicom files:

.jpeg, .jpg, .png

.pdf, .docx, .doc

.rar, .zip

.ima, .img, .dcm

Note: Documents in German and English are accepted. You can upload a total of three attachements with a maximum size of 5MB. Please do not send links since we do not open them due to safety reasons.

We would like to point out that a misuse by third parties during the transfer of medical data via the internet cannot be exempt. However, once received by the INI - International Neuroscience Institute® Hanover the data underlies medical confidentiality.