Make an appointment for consultations.

Make an appointment

MAR - Contact form

If you would like more information about your particular case, you can fill in the contact form below.

Our MAR centre will answer you as soon as possible.

At which e-mail address can we reach you?*

What is your gender?*

Female

Male

How old are you?*

Are you affiliated with a Belgian mutual insurance company?*

Yes

No

Would you like to carry out a fertility treatment with your partner?*

Yes

No

If so, with a man or a woman?

Man

Woman

How old is he/she?

Are you currently being treated on our Centre (Chirec)?*

Yes

No

What language do you speak?*

Would you like more information about sperm donation?

Yes

No

If yes, with an anonymous or known donor?

Anonymous donor

Known donor

Would you like more information about oocyte donation?

Yes

No

If yes, with an anonymous or known donor?

Anonymous donor

Known donor

Would like more information about:

Oocyte freezing (Social freezing)

Sperm freezing

A co-parenting project

Surrogacy

Other

You can only choose 4 optionss.

Other: please specify