Second Opinion Radiology Application

Please fill out the radiology form and click "submit".

With clicking "Submit" I declare that I agree to the use and processing of my personal data by Wiener Privatklinik / Vienna Private Hospital through authorized personnel, for the purposes of:

□ forwarding medical information (e.g. medical history, reports, laboratory results, etc.) to my preferred doctor or a doctor recommended by Wiener Privatklinik/ Vienna Private Hospital for the requested services;
□ transmitting my personal data, including health data, to third parties, as : Radiology Centers, pathology laboratories, blood analysis laboratories, medical specialists, physicians in order to receive medical information, to get in touch with medical staff and to be able to follow a possible medical treatment;
□ take over my contact details to receive newsletters, offers, medical messages from WIENER PRIVATKLINIK BETRIEBS-GES.M.B.H. & CO.KG
□ transmitting my personal data to an authorized translator for translating my documents.

I have been informed about the rights that the data subjects have: the right to information, the right of access to data, the right to interfere with data, the right to opposition, the right of not to be the subject of an individual decision, the right to delete the data (the right to be forgotten), the right to withdraw the consent granted, understanding that this action leads to the impossibility of continuing the previously accepted relationships, without affecting the legality of the processing carried out until the withdrawal of the consent and without affecting the obligation to pay the services offered.
I have been informed that my personal data will be retained solely for the fulfilment of accepted purposes as well as those based on other legal grounds than consent