Tandgenoten - Registration

Personal information

Initials

First name

Last name

Date of birth

JJJJ

Burgerservicenummer (BSN)

BSN

Contact information

E-mail address

Telephone number

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Information

We gladly welcome you in our practice. With this form you can register yourself. We will contact you for the intake after we receive your form. Please take a valid identification card and your insurance card with you to your first appointment. If there is a positive agreement between both parties (practitioner and client), we will finalize your registration.

We kindly ask you to request your files with the previous dentist.