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>>Appointment request : 1st step (personal data)

AppointmentsThis form allows you to ask for an appointment online.
We will call you by phone or GSM to definitely fix the desired appointment.

Therefore you can submit an appointment request for the following consultations :

Horta site : Breast Clinic | Cardiology (consultations) | Dermatology | Dietetics | Digestive, coelioscopic and thoracic surgery | Endocrinology | Fertility - sterility - menopause | Gastroenterology (consultations) | Gynecology | Heart surgery | Help for smokers | Hematology | Hypertension | Immuno-Allergologie | Infectious diseases | Internal medicine | Nephrology | Neurological rehabilitation | Neurology | ORL (Otorhinolaryngology) | Obesity | Oncology | Ophthalmology | Orthopedics and traumatology | Pain clinic | Physical medicine and rehabilitation | Plastic surgery | Pneumology (consultations) | Prenatal and high-risk pregnancy | Preoperative anesthesiology | Psychiatry (adults) | Psychiatry (children and teenagers) | Radiology (Scan, XR, NMR, Echo, Doppler, Angio) | Rheumatology | Senology | Stomatology and dentistry | Surgery | Travel clinic | Urology | Vascular surgery |

Brien site : Abdominal surgery | Anesthesia | Cardiology | Child orthopedics | Dentistry | Dermatology | Endocrinology | Gastroenterology | General surgery | General surgery | Gynecology | Hemato-oncology | Internal medicine | Logopedy | Neuro-psychology | Neurology | Neurosurgery | ORL | Ophthalmology | Orthodontics | Orthopedics | Paediatrics | Pain clinic | Plastic surgery | Pneumology | Psychiatry | Psychology | Rheumatology | Stomatology | Urology | Vascular surgery |

You will find useful contact data via the electronic list of consultations and consultants.
It is also possible to cancel (or re-arrange) online an existing appointment, or to use our free phone line (cancellations for Horta site only) : 0800/35.088.

Please fill in all fields marked with an asterisk *.

Is this appointment request for you or for another person ? *

Information about the patient :

Has the patient already been treated at Brugmann UH ? *  Yes  No

Gender * : Male  Female 

Last name *
First name *
Birthdate (dd/mm/yyyy) *

Street *   Nr *   Mailbox
City * Post code *

Electronic address of the person submitting the request :

E-mail *
E-mail (checking) *

Preferred contact method (so that we can reach reach you during office hours) :

Telephone * : >>Telephone * (checking) :
GSM * : >>GSM * (checking) :

! In case of urgent request, thank you for favouring direct contact (by phone or on the spot).
In case of life-threatening emergency, call the following number : 112.

IRISchu brugmann•Head office : Place A. Van Gehuchten 4 - 1020 Brussels•Tel.+32 (0)2 477.21.11
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Page updated on 2012-08-08