Register

Welcome to our clinic. Of course you can also call for an appointment, but completing the registration form below speeds up the process. At ‘Remarks’ please add the initials of relatives you want to take with. We will contact you the next working day.

  • Personal data

  • (Specially reassuring for children)
  • DD slash MM slash JJJJ

  • Address

  • Health insurance

  • If you visit our clinic for the first time, always bring your insurance card with you.
  • DD slash MM slash JJJJ

  • We only use your personal data in communication with you to provide you with the best possible service. See also our Privacystatement. By clicking on send you do agree.

  • Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.