Formulaire

Declare your attending physician

Cerfa 12485*03 (S3704b)

  • Any insured person wishing to declare their attending physician
  • Service free
  • 5 steps
  • Language French

Fill out the form

Comment faire ?

  1. Fill out the online form
  2. Download the form
  3. Print it
  4. Sign it (you and your doctor)
  5. Send it by post to your health insurance fund

The form contains a leaflet.

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Verified 12 October 2026 - Public Service / (Prime Minister)