Refer your patient

Doctor to doctor

Are you in search of a complex or innovative medical treatment for one of your patients? We can help you find it. In order to do so, we kindly request you to provide information about his or her situation through this enquiry form.

Your case will be reviewed by our Care coordinators, who will reply to your request within 24 hours during working days.

Refer your patient

Step 1 of 3

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  • Please provide information about
    the referring physician:
  • Please spell your first name the same way as it appears in official documents such as your passport or drivers license.
  • Please spell your last name the same way as it appears in official documents such as your passport or drivers license.
  • This is the email address used for communication about your enquiry.
  • This is the phone number used for communication about your enquiry.
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