MIBB

Application for MIBB membership in case of an accredited center

    Institution

    Address

    Town

    Zip code

    Head of institution

    phone

    E-Mail


    Responsible physician for VAB at the applying institution:

    Name:

    Position:

    Phone

    E-Mail

    MIBB-/accrediated:yesno

    New member application together with the institute application:yesno

    Please additional fill out the application form for individual MIBB-membership

    Are there further physicians performing VAB at the applying institution?

    Further physicians performing VAB at the applying institution:

    Name:

    Email:

    MIBB-accreddiated: yesno

    Name:

    Email:

    MIBB-accreddiated:yesno

    Name:

    Email:

    MIBB-accreddiated: yesno

    Please fill out a separate application form of MIBB-membership for any individual physician not yet accredeted

    Technical Equipment available for VAB at the institution:

    Stereotactic / DBT table:

    Stereotactic / DBT upright:

    Sonographic VAB system:

    MRI coil and biopsy device:

    Interdisciplinary cooperation:

    Diagnostic imaging:

    Pathology
    (that operates according to the guidelines of the Swiss Society of Pathology):

    Gynecology / Oncology:

    By applying for MIBB membership you agree to make the following commitments:


    Please enter the correct Answer:

     
     
     
     

    MIBB Office c/o ADJUMED Services
    Birmensdorferstrasse 470, CH-8055 Zürich
    Phone: +41 44 450 10 64 (Only technical questions about the MIBB database will be answered by Phone.)
    Email: mibb@adjumed.ch
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