Send your question Should you have any questions, we will be pleased to help you. We will contact you within two working days. This form contains errors. Check the fields and send again. What is your question about? Please make your selection. New healthcare insurance Application CZ card or policy Request claim form Healthcare insurance advice CZ debit order Medical devices Information about my policy Online insurance Maternity care My bill from abroad My submitted bill Change my policy My reimbursements by CZ Travel insurance Waiting list mediation Compliment or suggestion Other Your question Personal details Title Mr Ms First name and surname Are you already a customer of CZ? yes no Do you have your CZ customer number at hand? yes no The customer number is stated on your policy and your CZ Zorgpas. CZ customer number Date of birth Postcode House number and possible suffix Email address We will send a confirmation to this email address Your telephone number (not required) We are sometimes able to help you faster if we call you We will only use your information for the purpose of answering your question. Everything that you fill in will remain confidential.