Request to be contacted by the advising doctor

Do you have a patient who is incapacitated for work and about whom you would like to speak to CM's advising doctor?

You can use the form below to indicate when the advising doctor can call you to discuss a specific file. Do not use the form to share medical or confidential information about your patient.
Multiple patients you have questions about? Complete one form per patient.

Doctor details

First name

Family name

E-mail address

Mobile phone

Riziv number

Patient details

First name

Family name

National Insurance number

Contact moment

Subject

Enter a brief description about what you want to discuss with the advising doctor. No medical or confidential content.

Moment

Indicate when the advising doctor can call you. Provide at least two moments, at the earliest in three working days.