Submit a request - Second Opinion

What is your role*
- I am an employee
- I am an employer
- I am a company doctor
- I am a solicitor/court
Unfortunately, because you are an employee, you cannot submit a request directly to us.

If you wish to proceed, you can forward the request to your company doctor. Your company doctor can then initiate a process with us. You will receive a copy of the request that is sent to your primary company doctor.

Please note: A company doctor is obliged to honour the request for a second opinion. More information Arboportaal.nl / Ministry of Social Affairs and Employment
You are an employer and disagree with or have doubts about the advice given by your company doctor. Or you disagree with how the UWV is treating your employee. And for that reason, you want to request a second opinion. We call this a second opinion because the term “second opinion company doctor examination” is reserved for a similar request made by the employee to the primary company doctor.

The report to the employer will be stripped of any form of medical information or privacy-sensitive data. The report focuses on the employee’s work capacity. No medical report will be sent to the primary company doctor. The employee cannot now exercise their right to block this work capacity advice.
You are a company doctor and are requesting a Second Opinion. We also need your details to register and process your request. The reason why a quote and order confirmation are necessary click here.
You are a lawyer or work at the court and are applying for a judicial expert examination/second opinion/medical representative. We also need your details to register and process your application.

Your name*
First name Last name
Employed by company*
Your E-mail*
Name of company doctor*
First name Last name
E-mail company doctor / occupational health department*
Comment(s)
This comment is included in the request to the company doctor.
Is there a need for telephone contact?
- Yes
Consent
By using this form, you agree to our Privacy Policy and to the storage and processing of your data by this website.

Company name*
Address*
Street + house number City Postal code
Contact person*
E-mail*
Phone*
Is there a need for telephone contact?
- Yes

Your Name (doctor/court)*
First name Last name
Phone*
E-mail*
Your personal e-mail address for direct communication and any (medical) reports
Name on quotation: Company name
Name on quotation: Address
Street + house number City Postal code
Is there a need for telephone contact?
- Yes

Company name
Initials*
Gender
Name (client)*
First name Last name
Address
Street + hous number City Postal code
Phone*
Mobile phone
Date of birth
DD dash MM dash YYYY
Function
E-mail*

First day of illness
DD dash MM dash YYYY
Explanation of case study
Consent
I agree to the privacy policy.