Medical Member Area - Medical Register

Medical Member Area (external application form)

To get access to BASF's Medical Member Area, please fill in this form completely.

Please note that after submitting the application, you will receive a message to the email address you provided. Using the included link, please confirm your identity within 24 hours, otherwise the application will be deleted.

After approval of your application by Corporate Health Management of BASF (information by E-Mail), you will go through the 2nd step of applying for an external IT user, which you will need to log in to this portal. Please complete this process as well. You can then log in to the portal and access the section "Medical Member Area".

Salutation

Title

First Name

Last Name

Mail Address

Confirm Mail Address

Phone number

Birthdate

Company name (External Partner)

Entity Name

Function

Street

House No.

Zip

City

Country

Region

I have informed the country/regional coordinating occupational physician (CCOHP / RCOHP) about my interest to get access to the medical member area

I have informed the CCOHP / RCOHP

Name of CCOHP / RCOHP

Reason for request

Text Verification

You can find our privacy policy here: [PDF]

I have read and accept the terms of use. [PDF]

Please use the print button to save your form data for your own.