Customer info | EA

About You

Please enter your personal details. All fields are mandatory to enable the access to the service. Information will be exclusively used by our medical professionals.

User name

First name

Last name

Date of birth

Gender

Country of residence

Mobile phone number*

Please enter the phone number to be used for the service

EMAIL*

Please enter the email address to be used for the notifications

Time at your location

I read and agree with the terms and conditions.

I read the privacy policy explaining how my personal data will be used and agree to share with Europ Assistance medical professionals my personal details.

The patient is a minor (<18 years old) and I confirm that I am the legal representative.