Home › Contact

Registration form

Would you like to register as a new patient at Dovident? You can do so easily using the online form below. While completing the form, you can immediately choose a convenient time for your first appointment, so everything is arranged in one go.

Once we have processed your registration, you will receive a confirmation of your registration and your first appointment by email. If anything is unclear or if we need additional information, we will contact you. Your registration is only final once you have received a confirmation from us.

Please note: the registration form is currently only available in Dutch. An explanation of the form fields in English is provided below.

  • Explanation of form fields
    • Geslacht → Gender (Man - male, Vrouw - female, Non-binair - non-binary)
    • Voorletters → Initial(s)
    • Voornaam → First name
    • Tussenvoegsel(s) → Middle name / prefix
    • Achternaam → Last name
    • E-mailadres → Email address
    • Telefoonnummer → Phone number
    • Geboortedatum → Date of birth
    • Straat → Street
    • Huisnummer → House number
    • Postcode → Postal code
    • Plaats → City
    • Land → Country
    • Staat u onder bewind? → Are you under legal guardianship?
    • Inschrijven → Register
    • Inschrijven en afspraak maken → Register and book an appointment