Registration for a Medical Check-up at a Helios Prevention Center

My Personal Information
My Registration

As part of my company anniversary, I am registering for a medical check-up (“Jubi Health Check”) at the following Helios Prevention Center (HPC):

The preventive examination will be billed directly to my employer.

Additional Services

The Helios Prevention Center will contact me by phone or email to arrange the exact appointment or for preliminary discussions.

Declaration of Consent

This declaration of consent can be revoked at any time, in whole or in part.

Please add 9 and 8.