Register with the General practitioner

New Patients

You are a new patient who wants to register: press here

Family Expansion for Existing Patients

If a family member is already a patient at our practice and you want to register more familymembers, that’s always possible. As an adult, it is advisable to call the practice first (tel. 030 670 0979).

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