Registration form

Constats asbl

You will find below the registration form to send us duly completed by mail, fax or by post.

It is only when this form 'll be in our possession that we will put the patient in question on the waiting list. A confirmation of receipt will be sent to you.

 

The form is available in two electronic versions, one to fill via computer, the other to print and fill by hand.

 

To easily download these forms, be sure to preferentially use Google Chrome or Mozilla Firefox browsers.