Sign-up for care

All information that we register is protected by medical confidentiality.
Please come to the clinic within two weeks with a proof of identity (passport/ ID/ driving licence (no copies) to validate your registration.
You are welcome to do this from Monday to Friday, between 08:00 and 12:30 and between 13:00 - 17:00. No appointment necessary.

Your name
(in case married)
Contact information
(street & number)
Insurance & identification
(Please type 'not yet' if you do not have an insurance)
(Please type 'not yet' if you do not have a client number)
(The identification code of your insurance company)
(A BSN (burgerservicenummer) is the citizen service number, a unique registration number for everyone who lives in the Netherlands)
Medical history
Previous General Practitioner
Pharmacy
In case of an emergency
Family
Relative already registered
Extra family members
Another family member (1)
Insurance & identification family member (1)
(Please type 'not yet' if you do not have an insurance)
(Please type 'not yet' if you do not have a client number)
(The identification code of your insurance company)
Extra family members
Another family member (2)
Insurance & identification family member (2)
(Please type 'not yet' if you do not have an insurance)
(Please type 'not yet' if you do not have a client number)
(The identification code of your insurance company)
Extra family members
Another family member (3)
Insurance & identification family member (3)
(Please type 'not yet' if you do not have an insurance)
(Please type 'not yet' if you do not have a client number)
(The identification code of your insurance company)