Stenum Hospital
patient area
New Patients
Evaluation Form
Insurance Process


If you would like to expedite the process, after submitting your form, please send via FedEx or DHL, copies of x-rays, MRI's medical reports and other info to;

Stenum Hospital
Attn: Malte Petersen
Heilstaettenweg 1
Ganderkesee/Stenum, Germany, 27777

Malte Petersen, tel#:
011 49 422-3 71-335

or contact Jim Rider
1-866-544-8252
(pacific time zone)


Evaluation Form
Evaluation Form

New Form getadr

To begin the evaluation process;
First, complete the form below and click "submit"
or send an email with this information to info@stenumhospital.com
You will then see more instructions and a link
to download our patient data form.
Then, send your images, reports, and completed
patient data form, to Stenum Hospital.

Affiliate: getadr

  * Indicates a required field

First Name
Last Name
DOB Year Month Day
Height Ft. In.
Weight
EMail
Address
City
State>
Country
Zip
Phone
Fax
Comments
  Please include, description of your pain, summary of any diagnosis or MRI reports, previous surgeries (type of procedure, levels treated), other medical conditions, etc.
Select YES if you would like us to send you our Information DVD or click here to view the video online.