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Solentra offers specialised psychological care. It is therefore not possible for clients to make an appointment directly. Registration can only be done by a healthcare or service provider (GP, psychiatrist, social worker, CLB employee, etc.) using the registration form below.

Do you want to register as a client? Make sure to discuss the option with your direct care provider.

Register a client

Identification Referrer

Name Referrer*
Address*

Identification patient

DD slash MM slash YYYY
Address*
DD slash MM slash YYYY

Identification general practitioner

General practitioner (GP)*
Name GP

Identification school

School*
Address school

Identification family

Are there family members present in Belgium?*

Mother

Name
DD slash MM slash YYYY
DD slash MM slash YYYY

Father

Name
DD slash MM slash YYYY
DD slash MM slash YYYY

Sisters

Name
DD slash MM slash YYYY
Name
DD slash MM slash YYYY
Name
DD slash MM slash YYYY
Name
DD slash MM slash YYYY
Name
DD slash MM slash YYYY

Brothers

Name
DD slash MM slash YYYY
Name
DD slash MM slash YYYY
Name
DD slash MM slash YYYY
Name
DD slash MM slash YYYY
Name
DD slash MM slash YYYY

Problem

Have parents/family/centre been informed?*
Do you want to stay up to date on Solentra's activities?

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