Diagnostic request - polysomnography

St-Elisabeth site - Uccle

St-Michel site - Etterbeek

Bella Vita Medical Center - Waterloo

External consultation Inkendaal

Portail patient

Last name

First name

Are you already a patient at the Europe Hospitals??

Yes

Date of birth (dd/mm/yyyy)

Address

E-mail address

Telephone number

Requestor

Reason for examination

If the test is to detect sleep apnoea, please specify whether you wish to have this test carried out during an overnight stay in hospital or at home (ambulatory polysomnography).

Doctor to discuss results

Dr SMETCOREN Charlotte

Dr ROUGUI Ihsan

No preference

Please note that polysomnography is only reimbursed once a year. Please ensure that your last diagnosis was made more than a year ago.

asbl Cliniques de l’Europe – Europa Ziekenhuizen vzw
N° d’entreprise : 0432011571

Diagnostic request - polysomnography

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