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Allianz Registration

Allianz Insured Patient’s Registration.

Please fill the appropriate Form if you want us to do Direct Billing with your Allianz Insurance Company.
The Hungarian National Insurance – TAJ Card – is not accepted as payment.
We may use the TAJ Card number for registration only.

Allianz World Wide Care Insured Patients Initial Registration needs to be done only once, when you enter our practice. You may need to register again, if there is change in your data, such Policy Number, Name or Employer.

Patient Data and Medical History Collection Form

Patient Data Additional Information or Clarification

Additional or Supplemental Information Option.