Initial Contact Request

If you are interested in being (re-)certified, please submit an initial request.

In response, we will send you a non-binding cost estimate and a further information regarding the next steps.

Once you return the agreed and signed cost estimate, this constitutes a legal contract and we will initiate the certification process.

Initial Request Form

You are:*
Abfrage-Kunde*
- Hospital / Doctor
- Patient / Family Member
Advice to patients and relatives
Please note that EuroEndoCert does not answer to inquiries from private persons. For general questions, please contact EEL or SEF.
Information about the institution*
Ohne Titel*
Address*
Street Address ZIP / Postal Code City Country
Number of patients treated / operated in the preceding calendar year with the diagnosis N80.x*

Number of patients treated / operated in the preceding calendar year with the diagnosis N80.x
VAT
Head of Centre/Unit/Practice*
Ohne Titel*
Name*
First Last
email*
Coordinator of Centre/Unit/Practice*
Ohne Titel
Name
First Last
Email
Commercial responsibility*
Name of institution*
Ohne Titel*
Name*
First Last
Address*
Street Address ZIP / Postal Code City
Requested certificate*
*
- Endometriosis Practice: Download for questionnaire and criteria for certification
- Endometriosis Unit: Download for questionnaire and criteria for certification.
- Endometriosis Centre: Download for questionnaire and criteria for certification.
Your message to us*
Privacy Policy*
- I agree that EuroEndoCert GmbH will process and store my personal data for communication in the matter requested by me in accordance with the data protection declaration. A forwarding to third parties does not take place. I can revoke my consent to the use of my personal data at any time with immediate effect.
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