We provide
the right assistance
the moment it is needed

Welcome by Smartmelden

We ask you to complete a number of questions after which we can create a file. Completing this form will take approximately 5 minutes

Have you already contacted another emergency center?

Which emergency center did you contact?

Have you already received a payment guarantee?

Nature of the complaint

What do you need help with?

Name of the hospital

Location ot the hospital

Have you been admitted or do you want to visit a doctor?

What is the treatment or admission date?

Briefly describe your situation

Have you paid a deposit?

How much was the deposit in euros?

First name

Last name

Gender

Date of birth

Zip code

House number

Street name

Residence

On which phone number can we reach you?

E-mail

Your health insurance

Health insurance policy number

Reason for your trip

Your travel insurance

Travel insurance policy number

I travel by

Original departure date

Planned return trip

Other details

Thank you for completing the form. Your report will be picked up by our emergency services, after which they will contact you (by telephone) as soon as possible.

SOS Services

Diensten

Over ons

Onze aanpak

News & Média

We provide
the right assistance
the moment it is needed

Welcome by Smartmelden

Our office location

SOS Services

Diensten

Over ons

Onze aanpak

News & Média

We provide the right assistance the moment it is needed

Welcome by Smartmelden

Our office location

We provide
the right assistance
the moment it is needed