Contact form Immunology

Name: *

Last Name: *

Date of Birth: *

Attending physician in the outpatient clinic (if known):

Your message: *

Email address: *

Password (enter an individual password so that the MHH can contact you by email in a protected manner. Requirements: min. 10-digit, max. 32-digit, lower and upper case letters, special characters and numbers)::

I have taken note of the following information obligations, which fully inform me about the use of the data provided via the contact form: My personal data will be stored and processed on the server of the MHH computer center in accordance with data protection regulations, in particular the GDPR. Access to the data is granted to medical assistants as well as physicians of the Clinic for Pediatric Pneumology, Allergology and Neonatology. The processing of the personal data provided by me serves to contact me in order to clarify my concerns. My personal data will be disclosed within the MHH exclusively to those areas and persons who need this data to fulfill contractual and legal obligations or to implement the legitimate interest of the MHH. My personal data will not be passed on to a third country or an international organization. After collection, my data will be stored in the Clinic of Pediatric Pneumology, Allergology and Neonatology for as long as necessary to fulfill the purpose. Generally, this means that my personal data will be deleted or anonymized after the request has been completed. Existing retention obligations and periods will be observed. In the event of a revocation, my data provided via the contact form will be deleted. In the privacy policy linked above the form, I have taken note of the rights regarding the personal data concerning me according to the GDPR. *