Dentale Care Rogiers

Dennenlaan 69

2610 Wilrijk

Tel: 03 / 830 26 16

E-mail: [email protected]

Inscription New Patient

To make your first appointment with the dentist go smoothly, we ask you for the following

fill in data and medical questionnaire in advance. As soon as we receive it, we will contact you to schedule an appointment.

Thia data is linked to your file and is not used externally.

In the event of a charge of medical data, you must report this immediately to the practice.

Click here to fill in the medical questionnaire beforehand and send it later.

See you soon!


Hier niets invullen!