Patients
Registration form

Each person that is interested in Lymphology and is informed by the philosophy of BeLymph, can become adherent member of BeLymph. Consequently, each member of BeLymph has to approve the Charter of BeLymph. The membership fee for patients is free.

Upon receipt of your registration, we will send you an email with the confirmation of your inscription.
After controlling your details (whether you are not a health care provider), we will send you an email with your username and password. This information is necessary to have full access to the BeLymph website.

Registration can be done by completing following inscription form:

Name

First Name

Sex

Female

Male

Date of birth

Address

Street

Nr

Postal Code

City

Phone Number

Email

Kind of oedema

Primary lymphoedema (from birth)

Secundary lymphoedema (acquired after treatment for cancer for example)

Lipoedema

Other:

Localization of edema

Arm(s)

Leg(s)

Trunk (for example breast)

BeLymph charter

I have read and approved the charter of BeLymph.

Enter Code

Patients Registration form

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Patients
Registration form