Application for MIBB

    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: