Registration form

Please read our registration procedure carefully before registering with us.

 

Please note: you will always receive a confirmation email on the same day of your registration. If this is not the case, your registration did not come through properly. Please try again. 

 

REGISTRATION FORM

Your information details will be stored and processed in a secured environment on a private owned server and will not be accessible to third parties.



   








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In case you don't have a BSN number (Social Security Number), please enter nine zero's.

Make sure to provide the number to us at a later time, since without a BSN number,
the cost can't be referred to your health insurer











Attach your referral letter (optional, max 4MB)
You can also upload the email confirmation from your GP of the referral through the Zorgdomein system. Be aware that the referral is mandatory in order to be invited for a first appointment.

 

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