Nobelstraat 5
3128 Baal

016/53 75 51
016/53 16 18
03/320 59 07

  Orthopaedic Surgery
Sport Traumatology
Evaluation of Human Damage
Make an appointment
  Location & Route map Route Map Pictures Loco-Motion Pictures Nederlands Nederlands English  
< Guidelines for evaluation of human damage > < Questionnaire regarding compensation for accident injuries >

Consultation regarding compensation for accident injuries

To prepare for a consultation with Dr. Vanermen it is recommended to fill out a standard document regarding compensation for accident injuries. Please do this as accurately as possible and bring the document with you to the practice. This way it will be easier to place your profile on file. It’s very important that the doctor knows every detail about your situation. The form for completion also functions as some sort of reminder so you don’t forget to mention important details about your personal condition.

Please follow the following three simple steps that are necessary to fill out the questionnaire regarding compensation for accident injuries.

Download Acrobat Reader   In order to view and/or print the questionnaire Acrobat® Reader™ is required. If you don’t have this application installed on your computer, then please press the icon on the left - Get Acrobat® Reader™ - to download and install it.

Click on the link below to download and open the questionnaire. In some web browsers it will be opened right away, but you can always use the Acrobat® Reader™ application to open it.


Use the print-icon or command to print the questionnaire immediately on a standard A4 paper format.

Enter the requested information and don't forget to bring the questionnaire to the consulstation.