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The Fast Lane to Mentally Healthy Employees.

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FAQ

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Training programs
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Medewerker aanmelden

Dit aanmeldformulier is de eerste stap naar spoedig herstel. We vragen geen medische gegevens in dit formulier en zullen alle informatie volgens de hoogste privacy standaarden behandelen. Als er nog geen arbodienst in beeld is kun je deze stap overslaan. Vul het formulier zo volledig mogelijk in. Wij staan in de startblokken om de best mogelijke zorg te leveren.

Voornaam

Achternaam

Organisatie

Plaats / Locatie Organisatie

Functie

Telefoonnummer

E-mailadres

Geboortedatum

Woonplaats

Postcode

Straat en huisnummer

Toelichting reden van aanmelding

Voornaam leidinggevende

Achternaam leidinggevende

Telefoonnummer

E-mailadres

Voornaam

Achternaam

Functie

Telefoonnummer

E-mailadres

Facturatie E-mailadres

Kostenplaats nummer

Naam bedrijfsarts

E-mail bedrijfsarts

Telefoonnummer bedrijfsarts

Naam contactpersoon Arbo

Functie

Telefoonnummer

E-mailadres

Toestemming bedrijfsarts

Ik geef toestemming de bedrijfsarts en/of juiste persoon binnen de arbodienst te contacteren voor overleg.

Algemene voorwaarden

Ik ga akkoord met de algemene voorwaarden.

Register employee

This registration form is the first step to a speedy recovery. We do not ask for any medical information in this form and will treat all information according to the highest privacy standards. If there is no occupational health service in sight, you can skip this step. Fill in the form as completely as possible. We are ready to provide the best possible care.

First Name

Last Name

Organization

Place / Location Organization

Function

Phone Number

Email Address

Date of birth

Place of residence

Zip code

Street and house number

Explanation of reason for registration

First Name Manager

Last Name Manager

Phone Number

Email Address

First Name

Last Name

Function

Phone Number

Email Address

Billing Email Address

Cost center number

Name company doctor

Email company doctor

Phone number company doctor

Name contact person Arbo

Function

Phone Number

Email Address

Company doctor's consent

I give permission to contact the company doctor and/or the appropriate person within the occupational health and safety service for consultation.

General terms and conditions

I agree with the general terms and conditions.

Register employee

The intake interview is the first step in a process. It is extremely important that there is a good connection between employee psychologist. Fill in this form carefully and we will immediately start working to get everything going.

First Name

Last Name

Organization

Place / Location

Function

Phone Number

Email Address

Date of birth

Street and house number

Place

Zip code

First Name Manager

Last Name Manager

Phone Number

Email Address

Name company doctor

Email company doctor

Phone number company doctor

Name contact person Arbo

Function

Phone Number

Explanation of reason for registration

Company doctor's consent

I give permission to contact the company doctor for consultation.

General terms and conditions

I agree with the general terms and conditions.