Online Referral Form

You can use the Online Referral Form below to ask for counseling about exposures during pregnancy and breastfeeding. Please be as precise as possible when filling out the form. This will help us to adequately assess the situation.

We will either contact you by phone for direct counseling or send you our response letter. Personal data is kept confidential. However, we cannot exclude that third parties may access this form during its transmission to our email address.

Encryption of an e-mail is necessary when it contains sensitive personal data. To date, only e-mail addresses ending in and guarantee end-to-end encryption for transmission by e-mail to an address.

Would you like to ask a question about drug exposure during pregnancy or breastfeeding?


 Last updated on 02/03/2022 at 16:04