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ESTHETIC/CONTOUR IMPLANT REGISTRATION

(breast, face, gluteal, sizer and similar implants)

for patients

 

You will follow 4 chapters: 1. identification, 2. doctor/clinic data, 3. your implant and 4. the implantation data.


Only fields marked with * are required, but the more you provide, the better. 
Fee: 16.05€ (incl. 7% VAT).

1. IDENTIFICATION (THAT´S ME)

*
*
*
*
 / 
 / 
*
*


2. DOCTOR / CLINIC DATA  (THAT´S MY DOCTOR)

who placed the implant(s)?

*


3. IMPLANT DATA

*
*


4. IMPLANTATION DATA

*
 / 
 / 

Implantwiki/Implant-Register® assures that the data will not be passed on. They can be evaluated for anonymous, scientific, statistical purposes, where no connection to a person is possible. The data is stored securely, inaccessible via internet. I consent collecting this data and processing it according to the privacy policy of this website.

If any problem or suspicion arise with the implant you have, we will contact you by e-mail. Please inform us if there are any noteworthy developments with your implant - good or bad.

Data can be queried on a patient-related basis if this is necessary for medical purposes (e. g. undesirable developments, change of doctor). You can use the contact form for any queries or add welcome@implant-register.com to your address book.

The registrant assures to be the named person to whom the implant was inserted and that all information is correct. The registrant consents to the processing of his/her personal data as described above. The consent can be revoked at any time by e-mail.

*
 EUR 

Your payment is via paypal. You can pay with your paypal account or by direct debit or credit card, selecting "open a PayPal account" and you will be redirected without having to open an account.

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