Notification of a chronic illness to santé24

Dear Customer

Due to the high volume of calls santé24 is currently receiving, you temporarily have the option of sending us treatments concerning a chronic illness using the form below.

Insurance no.

You can find your seven-digit insurance number on your insurance card.

Title*

Ms

Mr

First name*

Surname*

Date of birth*

Street/no.*

Postcode*

Town*

Phone*

Email*

I have been diagnosed with the following chronic illness *

(e.g. diabetes, or a chronic respiratory or cardiovascular condition)

0/3000

I regularly take the following medications*

0/3000

My treating physician *

(please specify name and address)

0/3000

* Required field

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