Register with the General practitioner

New Patients

The practice is currently accepting patients at a slow pace to ease the workload for the assistants. This means we accept a small number of patients per month, temporarily close when this number is reached, and open again each month. If you are a new patient and would like to register, please visit the following page to find our registration system.

Family Expansion for Existing Patients

If you are a patient and are moving in together or have had one or more children, you can always register them. As an adult, it is advisable to call the practice first. For children, you can use the registration form below.

Registration consists of 3 parts:

  1. personal data
  2. medical data
  3. permission to share information with other health care providers

Note: Complete these forms separately for each child.

    Personal data of the child:





    Identification:

    Parent(s):




    Address:






    Emergency contact:


    Insurance:



    Pharmacy:

    Previous general practitioner:




    Do you give permission to request the medical file from the previous general practitioner?

    yesno

    Overig:


    Do you agree to receive surveys for quality measurements for Huisartsenpraktijk het Zand (this is done by Qualizorg)?

    yesno