PRESCRIPTION RENEWAL Name Forname Matricule my email Phone I'm with I'm with Dr Jean-Marc Weber Dr Jean-Luc Weber Dr Marie-Laure Vander Zwalmen I wish I wish get the prescription in my postal mailbox pick up prescreption in the clinic I need I need physiotherapy prescription medicine prescription List of requested medication or type of treatment Service available only for patients that have been in CML in the last 12 months. This is not a contact form. Only valid for prescription renewals, not for new prescriptions. Sending fee may apply. Prescriptions for pickup are kept for one week only. Requests not respecting these rules are not treated. Service available only for patients that have been in CML in the last 12 months. This is not a contact form. Only valid for prescription renewals, not for new prescriptions. Sending fee may apply. Prescriptions for pickup are kept for one week only. Requests not respecting these rules are not treated. I agree 5 + 13 = Submit