Register with us

So you’re interested in Praktijk Onder De Linde. Thank you. We’re excited to meet you. Welcome Before we can do what we do best, we need to ask you a couple of questions.

What is your first and last name?

What is your first and last name?

What is the reason for your registration?

What is the reason for your registration?

May we ask you the following?

May we ask you the following?

What is your address?

What is your address?

WE WILL TAKE YOU WILL RECEIVE A MESSAGE FROM US ASAP

WE WILL TAKE YOU WILL RECEIVE A MESSAGE FROM US ASAP

  • What is your first and last name?
  • What is the reason for your registration?
  • May we ask you the following?
  • What is your address?
  • WE WILL TAKE YOU WILL RECEIVE A MESSAGE FROM US ASAP

What is your first and last name?

First Name

Last Name

When were you born?

D-O-B

What is the reason for your registration?

Reason for contact

When was the first day of your last menstruation?

Good for you! Welcome. We like it here very much. We hope you will feel at home soon. We are now going to ask you a number of questions about your pregnancy.

We can definitely help you with that! We are now going to ask you a number of questions about your pregnancy.

We really appreciate it you want to register with us! We will now ask you a couple of questions about your pregnancy.

Congralutations on your pregnancy, Let's get to know you a little better. The following questions are about your pregnancy.

Which hospital (OB/GYN) or midwifery practice oversees your pregnancy at this moment?

Who provides your pregnancy care at this moment?

How many weeks are you pregnant right now? If you don't know, you can leave this empty.

When was the first day of your last menstruation?

How many children do you have?

How many times have you been pregnant?

How many times have you been pregnant?

Do you have a partner?

Do you have a partner?

If yes, what is your partner's name?

What is your partner's first name?

What is your partner's last name?

Test

How long have you and test been trying to get pregnant?

Other means, please state

Other means, Please mention

How can we reach you?

What is your email address?

What is your phone number?

What is your address?

Postcode

Housenumber

Address Not Found

StreetName

City

Ok, we now have almost everything we need to know. We need to ask you one more thing:

Do you agree that we store your data and contact you by e-mail or telephone. The email to you may contain personal information.

If we are not allowed to store your data, it is not possible to form a medical file. We cannot provide you with the care you need. From privacy legislation we need your agreement for our services.

Do you want to tell us something else?

Do you want to tell us something else?