Home Contact Call (071) 516 14 15 Ask your question Address ActiVite headquarters Addresses Residential Service Centers Addresses Day care Addresses Meeting Centers Dementia Other addresses Complaints procedure Contact with the Client Council Change membership information Client registration form FAQ I am from hospital and need home care. Can I get Household Help? Can I keep my help if my municipality uses the Dynamic Selection Model? I have to pay a personal contribution but my help has not been. Is my help or care scheduled and at what time? Can ActiVite provide professional alarm follow-up? Can I register for pregnancy gymnastics? What are your courses? What are the benefits if I become a member? Is your question not listed? Downloads Client information leaflets Magazine Home Active ActiVite Messages ActiVite information (Witte Weekblad) Terms and Conditions Vital Journal ActiZ fast to AZ index agenda Courses Services for members Member organization Request care Rietveld SassemBourg Hussonshoek Organization Mission Vision Quality Responsible care Client council Innovation Supervisory Board Organization chart Partners Field ANBI status St. Steunfonds Basiszorg ActiVite bulletin Public annual reports (071) 516 14 15 Navigation Care at home Care and Help After the hospital Volunteer Services Need care or help? Caregivers Home services Residential service centers Locations Care apartments Small-scale living Care living plan Family participation Benefits in kind Interested? Well-being and health Exercise programs Courses Services and Discounts GeZZond Check Restaurants and Community Service Centers Member organization Work at Working at ActiVite Frequently asked Questions Need care? Client registration form ActiVite Messages Intensive care Coordinating nurses Client registration form Formulier uitvoeringsverzoek Medicatiebegeleiding op afstand Medicijngebruik Ontmoetingscentrum Dementie Specialistenteam Thuisbegeleiding Vrijheidsbeperkende maatregelen Zorgdossier * Verplichte velden Naam melder*: E-mailadres melder*: Rol van de melder: Arts Cliënt/mantelzorger Verpleegkundige Sociaal wijkteam Andere zorginstelling Gegevens zorgvrager BSN: Volledige naam*: Voorletters*: Geslacht: Heer Mevrouw Geboortedatum*: Adres*: PC en woonplaats*: Verzekeraar*: Polisnummer: Gewenste ingangsdatum zorg*: De zorgvrager is reeds in het bezit van een geldige indicatie*: Nee Ja, aanspraak wijkverpleging Ja, WLZ indicatiebesluit voor verblijf (verzorgingshuis of verpleeghuis) Ja, MSVT indicatiebesluit (vanuit ziekenhuis) Ja, PGB indcatiebesluit Particuliere overeenkomst Niet bekend Aanleiding zorgvraag*: Medische diagnose: Accessibility of care recipient for home visit *: Particularities: Contact information Name contactperson: Relationship to care recipient: Telephone number: Details of the GP Name of your family doctor: General practitioner phone number: After sending you will receive a confirmation to the specified e-mail address. Fields with * are mandatory. If you are unable to submit the form, please check that all mandatory fields are filled in correctly. Menu options Home Care at home Residential service centers Well-being & health Working at ActiVite Frequently Asked Questions Sitemap Organization What can you find where? News Contact AZ index Font size Upwards together for the best care