Doctor Change Request

From N/A, you will have the opportunity to request a change of your Family Doctor.

Important:

A change request is per person. If you would like to submit a change for your spouse/child(ren), you must submit an online form for each family member separately.

Your confirmed doctor change request will go into effect as of N/A.

Insured Information

SZV IDnr

This is a 9-digit number. As written on SZV medical card

First Name

Your name must match the name on your identification document.

Middle Name

Your name must match the name on your identification document.

Last/Maiden Name

Your name must match the name on your identification document.

Married Name

Date of Birth

Please select date using date picker on the right or type the date in using the following format day-month-year i.e. 08-Nov-1982

Email Address

You will receive an email confirmation

Home Phone

Only provide an active phone number. i.e. +1(721) 54x-xxxx or +590 (590) xxx-xxx

Mobile Phone

Only provide an active phone number. i.e. +1(721) 54x-xxxx or +590 (590) xxx-xxx

New Family Doctor