Dr Babendererde

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    With my signature I confirm the completeness and correctness of the information provided overleaf and above.


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    Information on data protection according to EU_DSGV

    Declaration of consent by the customer or their legal representative

    I expressly consent to the storage of my personal data I my child's personal data. All information is subject to medical confidentiality in accordance with Section 203 of the German Criminal Code (StGB) - this information will be used for my treatment and for communication with my dentist. Our company regularly checks your creditworthiness when concluding contracts and, in certain cases where there is a legitimate interest, also for existing customers. For this purpose, we work together with Creditreform Boniversum GmbH, Hammfelddamm 13, 41460 Neuss, from whom we receive the necessary data. For this purpose, we transmit your name and contact details to Creditreform Boniversum GmbH. The information pursuant to Art. 14 of the EU GDPR on the data processing taking place at Creditreform Boniversum GmbH can be found here: https://www.boniversum.de/eu-dsgvo/informationen-nach-eu-dsgvo-fuer-verbraucher

    Furthermore, I have been informed that I have the right to revoke my consent in writing at any time. I also consent to any necessary X-ray examinations being carried out on my child as part of the orthodontic treatment.


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    Note:

    The agreed appointments are reserved exclusively for you. Please avoid cancelling and rescheduling appointments at short notice, and we will charge you privately for appointments that are not cancelled at least 24 hours in advance and that could be booked elsewhere - in accordance with §§ 615 [regulations of the service contract] and 280. para.1 [breach of contractual ancillary services] of the German Civil Code (BGB) - and will invoice you for the loss of fees. We are also authorised to charge members of the statutory health insurance scheme in accordance with the scale of fees for dentists (GOZ).

    As a special service, we offer you a reminder of your appointments about 48 hours in advance.
    I hereby authorise my orthodontist to remind me of the above-mentioned point in the following way:




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