Crisis Team Notification Form

This form is only available for the length of time in which the Crisis Team is active.

Crisis Team Notification Form

1. Personal details

First of all, please provide your personal details.

Please note:
Boxes marked with a * are mandatory.

Which group do you belong to?


2. Information about your state of health

In the last 14 days, I have ...


3. Information about your incoming

In den letzten 14 Tagen habe ich ...


NOTE

Please also read the current instructions on our coronavirus information page.


4. Further details