With your permission to discuss and release information we can speak to whoever you wish. Please complete, sign and return this form and we will contact the person of your choice.

If you would like to pay your outstanding balance by credit card, you can complete and sign this form and send it to us by secure fax +41 41 379 0398. For other payment options, please contact us.

This form is to be completed by a patient (or guarantor) when injuries were caused due to the fault of a third party and led to medical expenses being incurred.

The purpose of this form is to give insurance companies permission to provide information and make payment of invoices regarding medical treatment to OVAG.