Registration form for the check-up
Dear participant,
You have decided to take part in an occupational health management program at the European Prevention Center (EPC-GmbH). Your employer has concluded a framework agreement with EPC on the provision of preventive medical services (check-ups) and has agreed to pay the treatment costs. Your employer will be invoiced for the services provided by EPC. This invoice contains neither diagnoses nor numbers, but only your name, your date of birth, the date of treatment and a total price. This serves the purpose of data protection and compliance with medical confidentiality. On the basis of this invoice, the costs can be paid directly to EPC by your employer.
Declaration of the participant:
I agree with the procedure described here. By signing below, I further confirm that I am entitled to make use of the preventive medical services as stated above at the expense and for the account of my employer. I have received a list of the individual benefits in advance.