From application to patient
To register as a patient in our practice, please complete the application form below. We will then process your application. We aim to send you a response within 5 working days.
Please ensure that all your old dental records are sent to us prior to the first appointment.
Once you have visited us for your first appointment, and there is a fit with the practitioner, you are officially registered as a patient.
If you experience severe pain symptoms before that moment, please contact either:
- your previous dentist,
- or, the Mondzorgpoli in Slotervaart hospital https://www.mondzorgpoli.nl 020 723 4848
- or, the Emergency Dental Clinic at OLVG East https://tandartsspoedpraktijk.nl 0900-8602
These clinics can normally see you the same day.
Please complete the questionnaire below:
-> Intake adult (16 years and older)
NOTE: when we receive your data (application form and/or old file), but you do not schedule an intake appointment within 6 months, we deactivate your patient card.