Registration form

You can register online at one of our practices here. As soon as your data has been processed in our system, you will receive a confirmation by email.
Do you want to register with several people? Please send a separate form for everyone (including children).

We only accept your registration if you have recidency in Badhoevedorp. If you live outside Badhoevedorp, we must refer you to a GP near you.

[[[["field5","equal_to","Yes"]],[["show_fields","field7,field8"]],"and"],[[["field36","equal_to","Yes"]],[["trigger_integration",null,null,"MailChimp"]],"and"]]
1 Step 1
Registration form
Family membersAlready subscribed?

Data new patient

Gender
News

I hereby give my previous general practitioner permission to transfer my medical data to Huisartsen Badhoevedorp.

Autorisation


I hereby authorize the electronic exchange of medical data to my pharmacy, healthcare providers and the doctor's post. See www.volgjezorg.nl for more information.

Autorisation
keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right
FormCraft - WordPress form builder

Het is erg druk aan de telefoon en balie. De wachttijd is soms lang. Daarom verzoeken wij u om niet te bellen, maar om online een afspraak te maken of een vraag te stellen aan uw huisarts. Dit doet u heel eenvoudig via MijnGezondheid.net of de MedGemak app. Dank u voor uw medewerking.