European Obesity Care

Booking form for your practical arrangements and bookings.

Dear Mrs/mr,

To make sure that we can make the correct booking for you,
like hotel and travelling, please fill in this form for us.

Patient name (as in your passport)
Patient birth date
Surgery date booked
Kind of surgery	Gastric Band Roux en Y Gastric Bypass
Choice of hotel	Acacia ** (4-stars) Brugotel * (3-stars)
Total number of persons (including yourself) travelling to belgium
Date of arrival in Belgium
Date of leaving Belgium
Travelling method	Airplane Eurostar Car

If travelling by airplane. Arrival in Belgium:
Date:
Flight Details: Company name
Flightnumber
Hrs landing

If travelling by airplane. Departure from Belgium:
Date
Flight Details: Company name
Flightnumber
Hrs departure

If you come by plane, do you want a private taxi/shuttle service to be booked at the price of aproximatly 170 Euro/trip:
At arrival from the airport to the hospital	Yes No
At departure from the hotel to the airport	Yes No

If travelling by Eurostar

Arrival in Belgium:
Date
Time of arrival in Brussels Eurostar/Midi

Departure from Belgium
Date
Time of departure in Brussels Eurostar/Midi

By experience, we know you will arrive at the hospital in Bruges about 01.30 hrs after your arrival in Brussels with Eurostar. This way we can estimate at which hour we have to book your consultation at the hospital.

If travelling by car
Estimated hour of your arrival in Bruges:

The price of the hotel is always exclusive the price of surgery offered by EOC. The hotel needs to be paid when you check-out by credit-card or cash payment. All hotels will require a 50% deposit payment in advance by credit card.