Qunomedical Feedback Form

Welcome to Qunomedical Partnerships! If you want to join our selected network of worldwide clinics, please enter the following information and we will be in touch with you to discuss further steps.

Person of contact*
Please enter the name of the main person of contact
Person of contact's job title*
Please enter the position of the main person of contact
E-mail*
Please enter the e-mail address of the main person of contact
Telephone*
Please enter the telephone number of the main person of contact (e.g. +90 123 456 789)

Doctor's CV (first main treatment field).*

Please attach the CV of your doctor, who will be involved in most of the surgeries. If you are a multispecialty hospital, just choose one. The CV should include education, previous work experience, memberships in national & international societies and the number of treatments performed per year.
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How many relevant treatments did the doctor perform in his/her career? (first main treatment field)*
Please enter number of relevant treatments performed for chosen doctor
Does the doctor have a specialization in a relevant field? (e.g. a proven specialisation degree in plastic surgery or dental implantology). If yes which?*
Please write down which specialisation doctor officially has
Is the doctor part of any relevant non-mandatory specialist society? (e.g. ISHRS for Hair Transplant doctors or German Society for Dental Implantology for dentists). If yes which?*
Please write down societies the doctor is member of
Does the doctor take part in any scientific or educational activity? (e.g. has published scientific papers, is a speaker at industry conferences, lectures at university). If yes which?
Please write down doctors scientific or educational activities
Which languages does the doctor speaks?*

EnglishGermanDutchFrenchSpanishItalian
Local certificates.*

Please attach local certificates (e.g. Ministry of Health).
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International certificates (optional)

Please attach international certificates (e.g. ISO or JCI).
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Please upload 5 before and after pictures (first main treatment field)

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Comments
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