Request form

Baluchonnage request and destination form

The request form is now only accessible online, via the following link:

REQUEST FORM

ATTENTION: It’s very important not to send us the old form by email starting April 1, 2025.

If you encounter any technical issues, please contact Halimatou Mohamadou, Project Manager for Répix, at halimatou.mohamadou@baluchonrepit.com.

No need to print anything anymore! You only need to complete the respite request online using the new interactive form. This form is then automatically integrated and processed by our Répix software.
Please note that you will receive an acknowledgment of receipt in your professional email inbox, along with instructions on how to send additional documents as attachments: medication list (very important), relevant evaluations (ISO-SMAF profile, ergonomic, or others). It will be very important not to modify the subject line of the email.

Here is the complete process:

We encourage you to read the preliminary information.
Please send us the respite request at least 3 months before the requested period begins. For example, for a respite in July, the request must be sent to us no later than April 1.
For any questions regarding the submission of the request, please contact our agents at service.clinique@baluchonrepit.com or by phone (select option 2 for clinical services).