Contact us

Do you want to submit a request, get more information, or simply ask us a question?

Fill out one of the forms below and we will get back to you as soon as possible.

Do you want to receive medical treatment in Belgium with assistance in the medical procedures? Please fill out the form below.

We do not handle urgent requests. It takes at least two months to obtain all the desired medical documents.

Your medical and personal data are processed with the utmost confidentiality, in accordance with the GDPR. They are only used for the management of your file and are never shared with third parties without your explicit consent.

Name and First name *

Status *

As an intermediary, please fill out the form for the patient.

Gender *

Email address *

Phone number

Home address *

City *

Country *

Date of birth

Attach files *

Medical report, copy of ID card/passport, and copy of insurance card.

Message

Submit

Would you like to receive more information about our support service and our processes? Feel free to contact us.