Ja, ik ben geďnteresseerd in deelname aan de landelijke werkgroep “E-mental health voor somatische aandoeningen”

 

 

Naam                                                                                                                                  

 

 

E-mail adres                                                                                                                     

 

 

Instelling                                                                                                                          

 

 

Afdeling                                                                                                                             

 

 

Postadres                                                                                                                        

 

                                                                                                                                             

 

                                                                                                                                             

 

Telefoon                                                                                                                            

 

 

Onderzoeksgebied (kort)                                                                                             

 

                                                                                                                                             

 

 

Opmerkingen en suggesties                                                                                        

 

                                                                                                                                             

 

Dit formulier graag retourneren naar drs. Irene Vermeulen, Radboud Universiteit Nijmegen Medisch Centrum, afdeling Medische Psychologie:

Mail:                     i.vermeulen@mps.umcn.nl

Postadres :         mw. drs. I. Vermeulen, Radboud Universiteit Nijmegen Medisch Centrum,

                               Medische Psychologie 840, 6500 HB Nijmegen