Data Protection Contact Form

Select request type*

Please let us know which data protection right you would like to exercise

Information

Data deletion

Object to processing

Request details*

Please explain your request briefly

Relationship with Medbase*

In what way have you been in contact with Medbase? For example, are you a patient in one of our medical centers (in which one)? Or are you a customer in one of our pharmacies (in which one)?

First name*

Last name*

Date of birth*

Email address*

Adress*

ZIP code*

City*

Country*

ID document*

Please upload a copy of a valid ID document

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