Huisartspraktijk Amstelveld | Mijn GezondheidsApp

You can register as a new patient by filling in the form below.

By pressing Send your information will be send to our administration.

After reviewing, you will receive a confirmation email.

Initials ^*

First name ^*

Last name ^*

Birthdate ^*

Email address ^*

Repeat email address ^*

Mobile number ^*

Social security number (BSN)

ZIP code ^*

House number ^*

House number addition

Street ^*

City ^*

Health care insurer ^*

Policy number

Pharmacy

City of birth

Country of birth

Previous doctor

Comment for doctor/medical history

I agree with registration at this practice and give permission to request my medical file from my previous healthcare provider.

Cancel

Register

Menu