Registration form

If you are looking for a general practitioner in Leiden, you can register with us by filling in this registration form. After you have registered, the assistant will send you a confirmation email. 

It is important that you inform your previous (Dutch) general practitioner by email or phone about your switch to us.

Beste bezoeker, wegens de zomervakantie is de praktijk en daarmee ook de inschrijvingen gesloten van vrijdag 23 juni t/m zondag 9 juli. Wij zien graag vanaf 9 juli uw inschrijving tegemoet.

Dear visitor, due to the summer vacation, the practice and therefore the registrations will be closed from Friday, June 23 to Sunday, July 9. We look forward to receiving your registration starting July 9.

"*" indicates required fields

DD dash MM dash YYYY
Address*
Privacy policy*
Handing over medical record
en_GBEnglish (UK)