• The possibility to submit an appointment request using the form below is only available to patients who are registered at our practice. If you are not registered and want to register, you can use the Registration form instead. After receiving the completed form, we will send you an appointment by e-mail. This is final unless we receive a cancellation from you. If we are unable to meet your request, we will contact you by telephone. If you have difficulty walking and climbing stairs, it is advisable to report this when booking the appointment. We will schedule and perform your treatment in a treatment room on the ground floor, Mathenesserlaan 194.
  • Data

  • Date Format: DD dash MM dash YYYY
  • Choice of practitioner

  • Reason appointment

  • Accepted file types: jpg, png.
  • Privacy

  • Tandzorg.nl processes medical data of patients. Due to the sensitivity of this data, privacy is our top priority. In our privacy policy you can read which personal data we process and what for. The privacy regulations also state what rights you have.

  • By completing this registration form you indicate that you want to register as a patient at TANDZORG.NL. Upon receipt, we will contact you by telephone to check your details and schedule an appointment. We kindly request you to have your social security number at hand.
  • Data

  • Date Format: MM slash DD slash YYYY
  • Contactgegevens

  • Overig

  • Reason of registration

  • Accepted file types: jpg, png.
  • Question/remarks

  • Privacy

    Tandzorg.nl processes medical data of patients. Due to the sensitivity of this data, privacy is our top priority. In our privacy policy you can read which personal data we process and what for. The privacy regulations also state what rights you have.
  • U kunt uw feedback met ons delen met dit feedbackformulier. Heeft u een klacht, dan zal de klachtencommissie van TANDZORG.NL uw klacht bespreken met de betreffende medewerker en binnen een week contact met u opnemen om een verder overleg te plannen.
  • Data

  • Date Format: MM slash DD slash YYYY
  • Privacy

    Tandzorg.nl processes medical data of patients. Due to the sensitivity of this data, privacy is our top priority. In our privacy policy you can read which personal data we process and what for. The privacy regulations also state what rights you have.