GP practice Mon-Fri 08:00-17:00 Pharmacy opening hours 09:00-11:45 and 14:00-16:00 at Hagedoornweg 40,

between 08:30 and 17:30 it is also possible to pick up a prescription at Hagedoornweg.

Registration form

Only if you live in postal code area 1031 or 1032, you can register as a new patient in our practice.

Please be aware: by filling out this registraion form, you agree to us collecting and storing the infromation you provide.

Citizen Service Number (BSN)

Last name*

First names*

Date of birth*

Gender*

Street name registered address*

House number*

Addition

Postcode (only 1031 or 1032)*

City*

Land*

If your registration address differs from your residential address [yes / no, if yes

Telephone number*

E-mail address *

telephone number

Previous doctor

Current pharmacy

Would you like to register at the Kamperfoelie pharmacy, location Asterweg?

Permission to process personal data

Yes

Permission to link with National Switch Point for Care https://www.volgjezorg.nl/

Yes

Other comments (no medical information)