Patient declaration on pharmacy choice

I am aware that, pursuant to Section 31 (1) sentence 5 of the German Social Code, Book V (SGB V), I have the right to freely choose the pharmacy where I wish to have my prescriptions filled. I have chosen to have my prescription filled digitally via the platform provided by The Body Clinic. I understand that I can only have my prescription filled through pharmacies that cooperate with The Body Clinic. Among these cooperating pharmacies, I retain the freedom to choose.

I request that my prescription be filled by the following pharmacy and delivered to me by mail order or courier:

• For patients residing in Munich: Stachus-Apotheke München, Karlsplatz 4, 80335 Munich

• For all other places of residence: Witzleben Apotheken oHG, Witzleben Apotheke 26, Kaiserdamm 26, 14057 Berlin