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Registration form

new patients registration form english

English registration form for new patients
  • Passport/ID card/driver’s license
  • Passport number/number ID card/number driver’s license
  • Think about cardio vascular disease and high blood pressure, diabetes, hay fever or asthma, thyroid disease, cancer (what kind of cancer?), kidney disease, epilepsy
    You can use this to make appointments online, request an e-consulation and repeat prescriptions. You do need to have DigiD to be able to log in.
    Only necessary if your previous general practitioner is in The Netherlands
  • Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.