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Appointment

I give Ellen Bisschop permission to consult with my GP and / or referrer

I would like to be notified of every consultation with my GP and / or referrer

I want to give a new authorization for each consultation with my GP and / or referrer

I want absolutely no consultation with my GP and / or referrer

Signature (at first consultation) (both parent if the child is a minor)

Download the intake form

If you want more information or wish to make an appointment

+32 486 80 39 35