Will you be starting work at Maria Middelares General Hospital as a trainee specialist soon? Please fill in this questionnaire as completely and accurately as possible and at least two weeks before you start your internship.

Many thanks for providing your information, and please feel very welcome in our hospital!

Assistantship

Free assistants contact Cindy Galle via cindy.galle@azmmsj.be. Interns (sixth-year master's degree in medicine) register via the student section (Go to Professionals > Interns and students).


General information

Address details (domicile)

Contact details

For example: +32 XXX XX XX XX

Bank account number

Example: BEXX XXXX XXXX XXXX

Marital status

You are obliged to state your partner below. Even if you are unmarried, but have a partner, please complete the fields below. If you do not have a partner, fill in the fields below with 'NA' (Not Applicable).

Practical

Upload a passport photo below (jpg). We expect a professional photo, in accordance with the standards as on your identity card. This means in civilian clothes with a neutral, white background. The photo is necessary to create your badge.

You will receive a confirmation email after you have successfully submitted this form. Be sure to check the spam folder in your inbox.