Welcome to the online registration

Online registration

Prerequisites for online registration

You already have an appointment at the Zollikerberg Hospital or at the birthing center Zollikerberg.
You have Swiss health insurance (KVG) with an health insurance card.

Data Entry

Please provide your personal information using an official identification document (ID, passport, or residence permit).
If you already have been admitted to the Hospital as an inpatient this year and your information has not changed since then, you do not need to complete the online registration anymore.

Alternative

If you prefer to register in person instead of online, we kindly ask you to arrive at the reception desk (as indicated in your invitation) with your insurance documents and an official ID 20 minutes before your appointment.

1. Health insurance card

Insurance card number

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I agree to electronic and secure coverage checks at my health insurance center.

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2. Personal information

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Title (optional)

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Last name

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First name

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Maiden name (optional)

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Date of birth

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Place of birth

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Sex

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Marital status

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Religion

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Nationality

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Address

Street

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House number

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Postal code

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City

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Country

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Phone number

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Mobile number

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Email address (optional)

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Different mailing address?

Yes

No

Use your own name?

Yes

No

Last name

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First name

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c/o (optional)

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Street

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House number

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Postal code

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City

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Country

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3. Contact person

Please provide the contact information of a person we can reach in case of an emergency.

I do not want to provide a new contact person (keep any previously provided contact person).

I do not want to provide a contact person (delete all previously provided contact person).

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First contact person

Degree of relationship

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Salutation

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Last name

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First name

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Use your own address?

Yes

No

Street

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House number

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Postal code

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City

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Country

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Phone number

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Mobile number (optional)

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Email address (optional)

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Second contact person

Degree of relationship

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Salutation

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Last name

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First name

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Use your own address?

Yes

No

Street

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House number

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Postal code

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City

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Country

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Phone number

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Mobile number (optional)

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Email address (optional)

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4. General practitioner

I don't have a general practitioner

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Search for a general practitioner

Search for your general practitioner in the list. If you cannot find your general practitioner, you can add your own general practitioner below.

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Add a general practitioner

Last name

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First name

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Street

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House number

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Postal code

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City

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Country

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Phone number (optional)

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Email address (optional)

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5. Reason for admission

Choose the reason for your registration

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Date of accident

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Accident number (optional)

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Referral

Self-Admission

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Referred by general practitioner

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Search for referring physician

Search for your physician in the list. If you cannot find your physician, you can add your own physician below.

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Add referring physician

Last name

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First name

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Street

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House number

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Postal code

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City

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Country

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Phone number (optional)

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Email address (optional)

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6. Insurance relationship

Accident insurance

Health insurance

Health insurance provider

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Insurance card number

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Insurance number (optional)

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Do you have a flexible or choice insurance?

Yes

No

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For flexible or choice insurances, full costs are covered for the general department. For the semi-private or private department, your financial contribution is required. The amount of this financial contribution has been contractually agreed with your insurance. Please contact your health insurance company for more detailed information regarding your cost-sharing model.

I have read and understood the information on flexible and choice insurance.

Yes

No

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Select in the field below under Insurance coverage how you wish to enter.

Insurance coverage

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Outpatient supplementary insurance:
Please let us know before your admission if you have any of the following outpatient supplementary insurances:

- Hospital Day Comfort by Sanitas
- PRIMEO by Helsana
- myFlex by CSS

HP (Advanced):
As a semi-private insured, you are entitled to treatment by specialists at the level of chief physician, senior physician, or attending physician, a quiet single room of comfort or standard category with a view of greenery, as well as other services analogous to your policy and our offer.

Private (Excellence):
As a private insured, you are entitled to a deluxe single room and free choice of doctor, as well as other services analogous to your policy and our offer.

Supplementary insurance

Health insurance provider

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Policy / Customer Number (optional)

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Newborn health insurance

Health insurance provider

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Policy / Customer Number (optional)

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Insurance coverage

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Newborn supplementary insurance

Health insurance provider

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Policy / Customer Number

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7. Activity

Activity

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Would you like to provide information about your activity? (optional)

Yes

No

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Occupation

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Company name

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Street

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House number

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Postal code

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City

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Country

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Phone number (optional)

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Email address (optional)

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8. Authorizations

Upgrading

For semi-private or general insurance patients who wish to access the services of a higher insurance class, we offer various upgrades.

Do you wish to receive more information about upgrades?

Yes

No

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For which upgrade do you wish to have more information?

Room change to single room (for general insured) CHF 200 per night.

Stay in a family room (at birth). For general insured CHF 490 per night, and for semi-private insured patients CHF 240 per night.

Upgrade from general to semi-private class, flat rates per day between CHF 1,000 and CHF 2,500.

Upgrade from general to private class, flat rates per day between CHF 1,611 and CHF 3,400.

Upgrade from semi-private to private class, flat rates per day between CHF 700 and CHF 1,000.

A staff member from the patient administration will contact you regarding the cost estimate and deposit payment.

Electronic patient record

Do you have an electronic patient record (EPR)?

Yes

No

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Please authorize Zollikerberg Hospital (including birthing center Zollikerberg) and its staff to access your electronic patient record before the start of treatment.

Do you wish to exclude this case for the upcoming treatment?

Yes

No

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In case of a case exclusion, no documents related to this medical case will be uploaded to your EPR by the hospital or the birthing center.

Medical information & document transmission

You agree that your treating physicians and imaging institutions may transmit medical data and image files to the physicians of Hospital Zollikerberg and the birthing center Zollikerberg, thereby releasing both your treating physicians and the imaging institutions from professional confidentiality. Furthermore, you permit the transmission of treatment-relevant information to other treating physicians and other healthcare professionals involved in the treatment process, also under the lifting of professional confidentiality. Additionally, you agree that relevant medical records may be forwarded to the insurance company's trusted physicians and to the competent cantonal physicians for invoice control.

Yes

No

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Sending of emails

Due to data protection and security regulations in email correspondence, Zollikerberg Hospital and the birthing center Zollikerberg is fundamentally prohibited from sending personal data via simple, unencrypted emails. Sending such data via simple, unencrypted emails is only permitted if you provide consent.

I consent to correspondence or sending of data in PDF, Word, or JPG format via simple email to the email address below. I am aware that emails sent in this manner may contain personal data or data subject to medical confidentiality. I am aware of the risks associated with sending such emails - particularly unauthorized disclosure and use by third parties - and I take full responsibility for it.

Yes

No

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Email address

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Quality assurance

Quality assurance is a central concern of our hospital. We continuously work to improve the quality of treatment for our patients. With your consent, your health-related data and medical history may be used internally by our hospital staff and collaborating experts for the purpose of securing and improving patient treatment. These experts are also bound by professional secrecy and are obligated to confidentiality.

Agree

Disagree

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Cost assurance

The Zollikerberg Hospital and the birthing center Zollikerberg are obligated to provide your health insurance or insurer with the necessary medical information for evaluating liability for services. If there is no or insufficient insurance coverage for your treatment and stay, you are responsible for covering the uninsured costs.

Liability

The hospital and the birthing center accept no liability for lost items and valuables not deposited in the safe. The place of jurisdiction is Zollikon and Swiss law applies.

9. Review & submit

1. Health insurance card

Insurance card number: ${formdata.personalangaben.versicherungskartenummer}

2. Personal information

Salutation: ${getFieldLabel('anrede', formdata.personalangaben.anrede)}
Last name: ${formdata.personalangaben.nachname}
First name: ${formdata.personalangaben.vorname}
Maiden name: ${formdata.personalangaben.geburtsname}
Date of birth: ${formdata.personalangaben.geburtsdatum}
Sex: ${getFieldLabel('geschlecht', formdata.personalangaben.geschlecht)}
Marital status: ${getFieldLabel('zivilstand', formdata.personalangaben.zivilstand)}
Nationality: ${getFieldLabel('land', formdata.personalangaben.staatsangehoerigkeit)}
Place of birth: ${formdata.personalangaben.heimatort}
Religion: ${getFieldLabel('konfession', formdata.personalangaben.konfession)}

Street: ${formdata.personalangaben.adresse.strasse}
House number: ${formdata.personalangaben.adresse.hausnummer}
Postal code: ${formdata.personalangaben.adresse.plz}
City: ${formdata.personalangaben.adresse.ort}
Country: ${getFieldLabel('land', formdata.personalangaben.adresse.land)}
Phone number: ${formdata.personalangaben.kontaktinformationen.telefonnummer}
Mobile number: ${formdata.personalangaben.kontaktinformationen.mobilenummer}
Email address: ${formdata.personalangaben.kontaktinformationen.emailadresse}

Different correspondence address

Last name: ${formdata.personalangaben.abweichendekorrespondenzadresse.nachname}
First name: ${formdata.personalangaben.abweichendekorrespondenzadresse.vorname}
c/o: ${formdata.personalangaben.abweichendekorrespondenzadresse.co}
Street: ${formdata.personalangaben.abweichendekorrespondenzadresse.adresse.strasse}
House number: ${formdata.personalangaben.abweichendekorrespondenzadresse.adresse.hausnummer}
Postal code: ${formdata.personalangaben.abweichendekorrespondenzadresse.adresse.plz}
City: ${formdata.personalangaben.abweichendekorrespondenzadresse.adresse.ort}
Country: ${getFieldLabel('land', formdata.personalangaben.abweichendekorrespondenzadresse.adresse.land)}

3. Contact person

Keep contact persons: ${formdata.angehoerige_behalten ? 'Yes' : 'No'}

No relatives specified.

First contact person

Degree of relationship: ${getFieldLabel('verwandtschaftsgrad', formdata.angehoerige[0].verwandtschaftsgrad)}
Salutation: ${getFieldLabel('anrede', formdata.angehoerige[0].anrede)}
Last name: ${formdata.angehoerige[0].nachname}
First name: ${formdata.angehoerige[0].vorname}

Use your own address?: ${formdata.angehoerige[0].adresseuebernehmen ? 'Yes' : 'No'}

Street: ${formdata.angehoerige[0].adresse.strasse}
House number: ${formdata.angehoerige[0].adresse.hausnummer}
Postal code: ${formdata.angehoerige[0].adresse.plz}
City: ${formdata.angehoerige[0].adresse.ort}
Country: ${getFieldLabel('land', formdata.angehoerige[0].adresse.land)}
Phone number: ${formdata.angehoerige[0].kontaktinformationen.telefonnummer}
Mobile number: ${formdata.angehoerige[0].kontaktinformationen.mobilenummer}
Email address: ${formdata.angehoerige[0].kontaktinformationen.emailadresse}

Second contact person

Degree of relationship: ${getFieldLabel('verwandtschaftsgrad', formdata.angehoerige[1].verwandtschaftsgrad)}
Salutation: ${getFieldLabel('anrede', formdata.angehoerige[1].anrede)}
Last name: ${formdata.angehoerige[1].nachname}
First name: ${formdata.angehoerige[1].vorname}

Use your own address?: ${formdata.angehoerige[1].adresseuebernehmen ? 'Yes' : 'No'}

Street: ${formdata.angehoerige[1].adresse.strasse}
House number: ${formdata.angehoerige[1].adresse.hausnummer}
Postal code: ${formdata.angehoerige[1].adresse.plz}
City: ${formdata.angehoerige[1].adresse.ort}
Country: ${getFieldLabel('land', formdata.angehoerige[1].adresse.land)}
Phone number: ${formdata.angehoerige[1].kontaktinformationen.telefonnummer}
Mobile number: ${formdata.angehoerige[1].kontaktinformationen.mobilenummer}
Email address: ${formdata.angehoerige[1].kontaktinformationen.emailadresse}

4. General practitioner

I don't have a general practitioner

General practitioner: ${getFieldLabel('hausaerzte', formdata.hausarzt.preselection)}

Last name: ${formdata.hausarzt.nachname}
First name: ${formdata.hausarzt.vorname}
Street: ${formdata.hausarzt.adresse.strasse}
House number: ${formdata.hausarzt.adresse.hausnummer}
Postal code: ${formdata.hausarzt.adresse.plz}
City: ${formdata.hausarzt.adresse.ort}
Country: ${getFieldLabel('land', formdata.hausarzt.adresse.land)}
Phone number: ${formdata.hausarzt.kontaktinformationen.telefonnummer}
Email address: ${formdata.hausarzt.kontaktinformationen.emailadresse}

5. Reason for admission

Reason for admission: ${getFieldLabel('besuchsgrund', formdata.besuchsgrund.grund)}

Date of accident: ${formdata.besuchsgrund.unfalldatum}
Accident number: ${formdata.besuchsgrund.unfallnummer}

Self-Admission: ${formdata.besuchsgrund.selbsteinweisung ? 'Yes' : 'No'}
Referred by general practitioner: ${formdata.besuchsgrund.arzteinweisung.hausarzt ? 'Yes' : 'No'}

Referring physician

${getFieldLabel('aerzte', formdata.besuchsgrund.arzteinweisung.preselection)}

Referring physician

Last name: ${formdata.besuchsgrund.arzteinweisung.nachname}
First name: ${formdata.besuchsgrund.arzteinweisung.vorname}
Street: ${formdata.besuchsgrund.arzteinweisung.adresse.strasse}
House number: ${formdata.besuchsgrund.arzteinweisung.adresse.hausnummer}
Postal code: ${formdata.besuchsgrund.arzteinweisung.adresse.plz}
City: ${formdata.besuchsgrund.arzteinweisung.adresse.ort}
Country: ${getFieldLabel('land', formdata.besuchsgrund.arzteinweisung.adresse.land)}
Phone number: ${formdata.besuchsgrund.arzteinweisung.kontaktinformationen.telefonnummer}
Email address: ${formdata.besuchsgrund.arzteinweisung.kontaktinformationen.emailadresse}

6. Insurance relationship

Health insurance provider: ${getFieldLabel('versicherungen', formdata.versicherungsverhaeltnis.versicherungsname)}

Insurance card number: ${formdata.versicherungsverhaeltnis.versicherungskartenummer}

Insurance number (optional): ${formdata.versicherungsverhaeltnis.versicherungsnummer}

Flexible or choice insurance: ${formdata.versicherungsverhaeltnis.flex ? 'Yes' : 'No'}

I have read and understood the information on flexible and choice insurance: ${formdata.einverstaendnis.flex ? 'Yes' : 'No'}

Insurance coverage: ${getFieldLabel('versicherungsdeckung', formdata.versicherungsverhaeltnis.deckung.deckung)}

Supplementary insurance

Health insurance provider: ${getFieldLabel('zusatzversicherungen', formdata.versicherungsverhaeltnis.deckung.zusatzversicherung.versicherungsname)}
Policy / Customer Number: ${formdata.versicherungsverhaeltnis.deckung.zusatzversicherung.policennummer}

Newborn health insurance

Health insurance provider: ${getFieldLabel('versicherungen', formdata.versicherungsverhaeltnis.neugeborenes.versicherungsname)}
Policy / Customer Number: ${formdata.versicherungsverhaeltnis.neugeborenes.policennummer}
Insurance coverage: ${getFieldLabel('versicherungsdeckung', formdata.versicherungsverhaeltnis.neugeborenes.deckung.deckung)}

Newborn supplementary insurance

Health insurance provider: ${getFieldLabel('zusatzversicherungen', formdata.versicherungsverhaeltnis.neugeborenes.deckung.zusatzversicherung.versicherungsname)}
Policy / Customer Number: ${formdata.versicherungsverhaeltnis.neugeborenes.deckung.zusatzversicherung.policennummer}

7. Activity

Activity: ${getFieldLabel('anstellungsverhaeltnise', formdata.arbeitgeber.anstellungsverhaeltnis)}

No employer specified.

Occupation: ${formdata.arbeitgeber.beruf}
Company name: ${formdata.arbeitgeber.name}
Street: ${formdata.arbeitgeber.adresse.strasse}
House number: ${formdata.arbeitgeber.adresse.hausnummer}
Postal code: ${formdata.arbeitgeber.adresse.plz}
City: ${formdata.arbeitgeber.adresse.ort}
Country: ${getFieldLabel('land', formdata.arbeitgeber.adresse.land)}
Phone number: ${formdata.arbeitgeber.kontaktinformationen.telefonnummer}
Email address: ${formdata.arbeitgeber.kontaktinformationen.emailadresse}

8. Authorizations

Information about upgrades: ${formdata.informationupgrades ? 'Yes' : 'No'}
Electronic patient record: ${formdata.epd.selected ? 'Yes' : 'No'}
Medical information & document transmission: ${formdata.einverstaendnis.nachbehandlung ? 'Yes' : 'No'}
Sending of emails: ${formdata.einverstaendnis.email ? 'Yes' : 'No'}
Quality assurance: ${formdata.einverstaendnis.qualitaetssicherung ? 'Agree' : 'Disagree'}

Confirmation

I hereby confirm the accuracy of the information provided. It is not possible to claim at a later point in time that I made an error or misjudged the insurance coverage.

I confirm the accuracy of the information provided.

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Your registration is being processed...

Registration successful

Thank you for your registration. Your personal data has been recorded, and your check-in is ready. We wish you a pleasant stay and a speedy recovery at Zollikerberg Hospital.

If you have any further questions or need assistance, our staff is here to help.

Welcome to theonline registration

Online registration

Prerequisites for online registration

Data Entry

Alternative

1. Health insurance card

2.

Personal information

Address

3. Contact person

First contact person

Second contact person

4. General practitioner

Search for a general practitioner

Add a general practitioner

5. Reason for admission

Referral

Search for referring physician

Add referring physician

6. Insurance relationship

Accident insurance

Health insurance

Supplementary insurance

Newborn health insurance

Newborn supplementary insurance

7. Activity

8. Authorizations

Upgrading

Electronic patient record

Medical information & document transmission

Sending of emails

Quality assurance

Cost assurance

Liability

9. Review & submit

1. Health insurance card

2. Personal information

3. Contact person

4. General practitioner

5. Reason for admission

6. Insurance relationship

7. Activity

8. Authorizations

Confirmation

Registration successful

Help with registration

Welcome to the
online registration