Dear patients, we support you with the preparation of reports, medical protocols and the provision of information to other doctors and medical institutes.

This service is a private additional service. As a patient, you must bear the costs yourself.

To order this service from us, please print out the order provided here, fill it in with the required information and return it signed by post or as a scan to the OCP Quirino practice.

Postal address: OCP Quirino, Antonio Quirino, Grütstrasse 55, CH-8802 Kilchberg ZH

Scan of the completed and signed order by e-mail to info@zuerichosteopathie.ch.

For the costs associated with the order, please refer to the GTCs on our website.

Download order form for private additional services

By signing this order, you as the patient/ authorised representative agree that  

• the costs for the preparation of reports/ protocols are not included in the osteoplastic services and will be invoiced separately and according to expenditure.
• the provision of med. reports in health insurance portals on behalf of the patient. are not included in the osteoplastic services and will be invoiced separately and at cost.
• the preparation of reports and med. protocols requires an advance payment of 90% on the part of the client (immediately and without discount).
• the amount of the costs incurred is defined according to the assessment of the effort on the part of the doctor/specialist therapist.
• after completion of the medical report/protocol the final payment by the client is to be paid immediately according to the final cost definition by the specialist/contractor (without discount).
• it is permissible to pass on patient information worthy of protection with the transmission of the requested information.
• the applicable general terms and conditions and the defined data protection are fully agreed to.
• the requested order will only be carried out on presentation of the signed order.