User Registration


All the fields in the form are mandatory to be filled upon. The request shall be forwarded to the respective Head of the Departments for approval and thereafter to the database administrator. Thereby, for any issues in the registration process, kindly contact CliniPhenome administrator's office. To track the status of your request use the application number generated during the form submission process.

Person to be registered

Mr Mrs

Confirmation of registration

I do hereby confirm all the information furnished in the form holds true. I will also abide with the UZ Brussels patient data protection regulations. I fully understand any violation may lead to immediate cancellation of my account and may be followed with Belgian legal jurisdiction.

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