Skin Cancer Screening

Skin cancer screening is part of the statutory health insurance benefits. However, this only includes a skin cancer screening a maximum of every two years from the age of 35. The examination is carried out with the naked eye. For this service, please book a “normal” consultation appointment. Filling out this questionnaire is not necessary for this.

For a more thorough skin cancer screening (also outside the 2-year cycle), we offer you two options:

1. Skin check with dermatoscope (without video documentation)
   Suspicious skin areas are checked with the dermatoscope (a magnifying glass for the skin) and can thus be better assessed.
2. Skin cancer screening with video documentation
   Suspicious skin areas are photographed and inspected more closely afterwards (including with the support of AI). At the next examination, the development of the suspicious skin areas can be accurately assessed by comparison with the previous photo and measures can be taken in good time.
   Further information at: Avimsed – Skin Cancer Screening

The list of the following services (cost estimate) represents a non-binding estimate of the expected costs. Deviations of the invoice amount from the cost estimate are possible and remain reserved within the framework of the statutory provisions (§ 650 BGB) (max. 15% deviation).

The services described are considered agreed and the costs are to be paid by you, regardless of whether your insurance reimburses them. You confirm this with your signature at the end of this form.

Invoice Assignment

We work with our partner AvisCode GmbH for invoicing and billing.
If you have any questions about billing, please contact us: rechnung@avismed.de

Your data will only be passed on on the basis of your consent and in compliance with the GDPR and the medical confidentiality obligation in accordance with § 203 StGB, which also applies to all AvisCode employees.

Thank you for your trust
Your Avismed Team

Please read the Information on data protection according to Art. 13 and 14 GDPR.

I agree with the

• Disclosure of the personal data required for billing and enforcement of the fee claims (e.g. name, date of birth, address, treatment and examination data) to AvisCode GmbH. I am informed that AvisCode uses external technical service providers to process this data, who act exclusively on behalf of AvisCode GmbH and are contractually obliged to comply with the applicable data protection regulations in accordance with Art. 28 GDPR
• Commissioning AvisCode by my doctor to create, send and manage invoices and payment reminders in my name, including the use of an online portal to provide this information
• Disclosure of information required for invoicing from the patient file to AvisCode and – in the event of a dispute – to courts or legal advisors. I release my doctor and the employees of AvisCode from the obligation of confidentiality to this extent.
• the release of Avismed from the obligation of confidentiality towards the external partner should there be different opinions in the course of the claim

I have been informed that my treatment is not dependent on agreeing to the processing operations described above. This consent also applies to claims arising from future treatments. This declaration is made voluntarily.
The consent can be revoked at any time with effect for the future. The revocation does not affect the legality of the processing that has taken place up to that point on the basis of this consent.
If the declaration is made as a legal guardian of a minor child, I assure that the other legal guardian also agrees to the above regulations.