PHYSICIANS · APPLICATION QUESTIONNAIRE

Let’s discuss professional cooperation.

Describe your qualifications and preferences. Terms and fees are agreed individually. Video assessment is in development; physician applications are open.

Scope of cooperation and fee arrangements

Fields are required unless marked optional. Do not include patient information, health data or document scans. An application does not create a public profile.

1. Contact and qualifications

Full name

Phone (optional)

Specialty / area of practice

Country of medical practice

Medical registration authority

Medical registration / licence number

Clinical experience

Experience in medical expert opinions (you may enter ‘none’)

2. Scope, languages and availability

Preferred scope (select at least one)

Video-supported opinions (service in development)Medical records opinionsExaminations in Germany (subject to licence verification)Medical quality review of reports

Working languages (optional — describe proficiency below)

PolishGermanEnglish

Language proficiency: records review, report writing, interviews; other languages

Video experience and access to a private room, camera and stable internet (optional)

Approximate monthly availability

3. Fees and consent

Preferred fee arrangement

Expected fee: amount, currency, per hour or scope (optional)

Additional information and possible start date (optional)

I confirm that I hold current medical registration in the stated country and that the information is accurate. Qualifications and permitted scope will be verified before cooperation.I consent to IMB Consult GmbH, Amtmann-Ibing-Str. 10, 44805 Bochum, Germany, processing the information in this form to assess my application and contact me about cooperation. I may withdraw consent at info@imb-consult.de without affecting the lawfulness of earlier processing. I have read the privacy policy.Privacy policy — physician applications

Check your email address and registration number. Confirmation is shown only after the application is saved.