Entry form first visit

The CRG doctor would like to receive as much information as possible about your medical history at your (first) consultation.
Please download the questionnaire, fill it out and bring it with you.
If the two of you follow (part of) the treatment, we would like to receive information about the both of you: entry form woman, entry form man.

Also important:

  • bring the results of previous examinations and/or treatments;
  • for Belgian patients with National Health insurance: if you have already had treatment, we need the health insurance reimbursement form which lists any previous treatments.