Course*:
Please choose...Monday 8:00 p.m. - 9:00 p.m. (continous course)

First name*:

Family name*:

Street / no.

Postcode / Town

Telephone*:

E-mail*:

Health Insurance*:

Date of birth*:

* Please fill out the marked fields

Information of your medical insurance

I am statutory insured and pay the course costs of 110€. I require a participation certificate for my medical insurance in order to get a 75% refund of the course costs.I am privately insured and wish a private medical bill for the course costs of 140€, to refund with the insurance.I am a self payer and I am going to pay the 110€ by myself and do not need a participation certificate or a bill to refund with the insurance.

Information to your payment method

The fee for the course is normally freed from the value added tax, when a documented relevant diagnosis is existent. This can also be done by Dr.Lemm.
If no diagnosis is evident, the 19% value added tax, as required by law, has to be paid in addition to the course costs. Further information you can find here.

Selection for value added tax

I am statutory insured or self payer and will additionally pay the 19% value added tax (total amount: 130,90€).I have following diagnosis:

diagnosis:

After receiving the booking confirmation (telephone or email) and at latest
2 weeks before course begin I will:

transfer the course costs to the following account number:

recipient: Vesna Lemm
subject: Pilateskurs
IBAN: DE63 3006 0601 0207 0269 00
BIC: DAAEDEDDXXX

If the payment is not made on time, the course spot will be given to next person on the waiting list.

It is possible to repeat the appointment, if in the course afterwards
a spot is free or a participant is hindered to take part.
In case you have the wish for this, please contact us per email (info@berliner-akupunkturpraxis.de),at the latest till the end of the course.
If you want to attend the course within a preventative measure of your medical insurance, it is necessary that we give you 8 appointments.
If you miss 1 appointment without cancelling, the costs of the whole course have to be taken over by you.

Comment / additional information:

I agree to the processing and the forwarding of the information I entered above. I can withdraw my consent at any time with immediate effect.

back to course programme