REGISTRATION FORM

Welcome to our practice. Inhabitants of the postal code areas 2311, 2312, 2315 and 2316 who do not yet have a GP in Leiden can register with us. After receiving this form, our assistant will create a medical record for you and, if available, will request your medical records from your previous doctor in the Netherlands. It is important that you inform your previous dutch doctor about your registration with us. Only then he/she can forward your medical file.

Please mind: we often receive many applications at once. It may take up to a few weeks before we process your registration. You cannot book appointments before you get the confirmation of your registration.

Note: the orange parts must be filled in order to process the registration.

Registration of new patients is not possible at this moment.