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 below, 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.

Do not forget to bring the following with you for your first consultation at the CRG:

• results of previous investigations and/or treatments;
• If you are a Belgian patient with a right to reimbursement and you have already received treatment: the reimbursement form of the health insurance company on which the previous treatments are listed.