Get Pedicure - Menzis

Filling out the Pedicure - Menzis form online can be a straightforward process if you follow the right steps. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to complete the form seamlessly.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Select the specific type of care needed by checking the appropriate box under 'Betreft'. This includes options like extramural ergotherapy, podotherapy, or pedicure.
3. In the 'Gegevens verwijzende arts' section, enter the referring physician's initials and last name, followed by their associated care group name, if applicable.
4. Provide the street address, postal code, and city of the referring physician, along with their phone number, fax number, and email address.
5. In the 'Verzekerde' section, fill in the insured person's initials and last name and their date of birth. Be sure to indicate their gender by selecting either 'M' or 'V'.
6. Input the insured number, street address, postal code, and city for the insured individual, as well as their phone number.
7. Record the referral date accurately to ensure proper processing.
8. Clarify the reason for referral in relation to disorders and limitations in the designated fields.
9. State your questions or concerns about the referral in the 'Vraagstelling' section.
10. In the 'Relevante medische gegevens' section, provide any relevant medical information necessary for the treatment.
11. Date and sign the form in the 'Ondertekening' area to validate the referral.
12. If applicable, fill out optional items for therapy proposals, treatment numbers, and requests for follow-up discussions.
13. Once all sections are complete, ensure to save changes, then download, print, or share the filled form as needed.

Start filling out your Pedicure - Menzis form online today to ensure timely processing.