BMHC Patient Admission Form

Find the right care.

Completed in +/- 3 minutes. Appointments often within 5 days.
- Caroline Watelet · Physiotherapy · Hypnosis · Relaxology · Somatic therapies 🇫🇷 🇬🇧
  
  Beate Trück 🍃 Indivdual Mindfulness Program 🇬🇧 🇩🇪 🇫🇷 🇳🇱
- ⏳ WAITING LIST
  
  Join a caregiver's waiting list.
- Lina Butkute, PhD · Individual Psychotherapy / EMDR / Couples Therapy · 🇬🇧 🇷🇺 🇱🇹
  
  Christopher Grogan, PhD · Clinical Psychologist · 🇬🇧
  
  Marjolein Stevens · Individual Psychotherapy · MBT · 🇳🇱 🇬🇧
  
  Dr. Thomas Van der Poorten · Psychiatrist · 🇳🇱 🇫🇷 🇬🇧
  
  Eric Lambrechts · Individual Psychotherapy (uniquement français)
- If a caregiver does not appear in the form currently,
  it means they are unavailable. Feel free to check back later.

Reason of consultation
A few words can be enough
Name
Referred by
Email
Phone Number
Your privacy is essential to us. The information you provide is handled in strict confidence and used only for your care, in accordance with our privacy policy.

Date of Birth
Home Address

City, Postal Code

Postal / Zip Code
How did you find out about us?
- Our fees aim to balance accessible care for patients with fair and sustainable working conditions for our clinicians.
  
  Psychologists & other clinicians
  From €90 per session, with possible reimbursement through Belgian statutory health insurance. Specific rates apply for JSIS and other private or international insurance plans.
  
  Psychiatrist
  Initial consultation from €98.
  
  Cancellations
  Please cancel at least 48 hours or 2 full working days in advance. For late cancellations or missed appointments, the full fee may be charged and this may affect future bookings.
  
  View full fees & reimbursement information →
  https://mentalhealth.brussels/en/fees/
- Before submitting, please read carefully.
  
  I confirm that I am applying to one clinician only and accept the fees, cancellation policy, and use of my data for appointment scheduling and care. I am aware of the provider's title, spoken languages, area of expertise and the limitations of their practice, as described on their profile page. I understand that initial sessions may be used to clarify my therapeutic needs, provide initial support, and, if needed, involve referral to or collaboration with other healthcare providers or services - and that this is an outpatient service, not emergency or crisis care.
- Please verify that you are human
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