+43 (1) 982 41 21

Telefonische Auskunft

Hütteldorferstraße 46, 1150 Wien

barrierefrei: Hütteldorferstraße 44

Ordinationszeiten: Mo-Do von 8-12 und 13-18, Fr 8-12

Telefonzeiten enden 30 Minuten vor unseren Ordinationszeiten

Referral form

You can book your appointment through the insurance or privately.

For appointments through insurance, please bring your E-Card and a valid referral form to the appointment so that your health insurance (ÖGK, SVS, BVAEB, etc.) can cover the relevant costs.

This applies to both new patients and patients who have already been to us and now have a follow-up appointment.

If you do not bring a referral form to the appointment, the Allergy Center Vienna West will not be able to bill the relevant health insurance, and the services provided will otherwise be charged to you privately.

For private appointments or purely private services, no referral form is required. These include, among others, the H2 breath test, nutritional counseling, the ALEX test, acupuncture, the pediatric pulmonological examination, and the exercise provocation test.

Please note that certain private services (e.g., the H2 breath test) may, depending on availability of our staff, also be performed on the same day along with other services (e.g., doctor’s consultation, prick test, blood draw, etc.), which would be covered by the health insurance. In such cases, a referral form and the E-Card would be required again. Therefore, we recommend that you bring your E-Card and a valid referral form (from your general practitioner or specialist) to your appointment, just to be safe.

Furthermore, there are certain private services (e.g., histamine intolerance test, celiac screening) that are mandatory and can only be offered together with other services (e.g., doctor’s consultation, blood draw, etc.), which would be covered by the health insurance. For these services, a referral form and the E-Card would also be required. Therefore, we recommend that you bring your E-Card and a valid referral form (from your general practitioner or specialist) to your appointment, just to be safe.

The referral itself is actually only valid for one month. However, due to the long waiting time for an appointment, we currently accept referral forms that are up to 6 months old. For example, if your appointment is on September 10, the referral must have been issued between April and September; if your appointment is on October 2, the referral must have been issued between May and October.

If you have any questions or need to send your referral form before or after your appointment, please don’t hesitate to contact our staff at the reception, by phone at 01 982 41 21, or by email through our contact form.

Submit referral form later:

Drag & Drop Files, Choose Files to Upload You can upload up to 2 files.

Explanation of the referral

1
Social insurance

Here is your current social insurance, which is responsible for covering the costs of the examination (ÖGK, SVS, ...).

2
Patient's name

Here are your first name and last name.

3
Patient's insurance number

Here is the current ten-digit insurance number.

4
Patient's address

Here is your current address. Please check it, as we will send the report by mail to this address.

5
Patient's signature

You need to sign here. If you submit the referral form to us digitally, you do not necessarily have to sign it.

6
Diagnosis

Here is the current diagnosis from your doctors. Ideally, it should be phrased as "Allergy examination requested."

7
Date

Here is the current social insurance that covers the costs of the examination.

8
Doctor's signature

Here, your doctor must sign.