Registration

If you would like to get treatment, you can register by filling in the registration form below. After that you will receive a confirmation email and will be contacted for an initial appointment.

Please note, before registering we ask you to take note of our terms and conditions.

Registration form

Your email address

First name, Last Name

Address, Postal Code, place of residence

Date of birth

Phone number

BSN number

General practitioner, Health Insurance

Notification complaint

Request for help

You have read and agree to the general terms and conditions (working method, compensation and costs). If you enter "No", this form will not be processed.

Yes
No

Registration

If the form has been successfully submitted, you will return to the first page.

Bezoek adres

Email adres

WhatsApp of SMS