RiskCare -- Netservices --

Please select your language:

-This service is intended solely to clients of
Netservices Travel Assistance

As a client of Netservices Travel Assistance you have been directed to this website, as you encounter a medical problem during your stay in the Netherlands.
RiskCare is a Dutch medical company who will provide medical aid, assist and inform you, wherever you are in the Netherlands.

Please complete the mail form below and RiskCare will direct you to the nearest hospital, doctor or medical specialist, provide medicines, information, answer your questions, etc.
The communication with the Dutch doctor will be in the English language (via email or telephone). When language problems arise, Netservices Travel Assistance will intervene and converse back to you in your own language.

1. Verification

Please enter the login code (provided by Netservices):

(no capitals!)

2. Personal data

Name:

Date of birth:

Email:

(double check!)

Telephone:

(double check!)

Your current address in the Netherlands:

Street:

Number:

City:

-
If you know or prefer a local pharmacy in your neighborhood, you may complete these fields (not obliged):
Name:	Street: Number:	City :
Telephone:	Fax:	E-mail:

In order to have an optimal communication between you and your doctor or other professionals, we would like to know more about your languages:

Your home country and language:
Do you speak English?
Do you speak any other languages?

3. Medical information
What is your medical problem?
When did this problem start? (date and additional information)
Did you have this problem before? (when and additional information)
If so: what kind of therapy did you receive for this problem?
Are there any other important or chronicle medical problems?
What kind of medicine do you currently use, if any?
Are you allergic for some medicines? (if so, the correct names)
Are there any additional remarks or questions?

4. Approval

The data you submitted on this mail form and the results of medical treatments, can be sent to Netservices Travel Assistance upon their request.
By submitting this form, you give permission to RiskCare in forwarding your medical and personal information to Netservices Travel Assistance.