Request a Consultation

Dr Fanny M. Ballieux, MD

Clos des Peupliers 104
West-Vlaanderen
1200 Woluwe-Saint-Lambert
Belgium

First Name

Last Name

Phone Number

Please include your country code, and use parentheses, dashes or spaces to enter your phone number. E.g., “+1 555-555-5555” for the USA.

Preferred method of contact

E-mail

Phone

Procedure

Comments

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Indicates required field

Tip: Sign In or Create an Account to automatically pre-fill your contact info and track your consultation requests.