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Register new patient?

You are very welcome at the Hollands Spoor dental practice.
Please fill out the registration form below.
Once we have received your personal information, we will contact you to make an initial consultation and introductory meeting.

Registration form TEST ENG

    Preference for a dentist
    Dentist Paula GreweDentist Derk Kösters

    Surname *




    Date of birth

    Address *

    Postal code *

    City *

    Phone number *

    Your Insurance company *

    Insurance Policy Number *

    Email address *

    Name current dentist

    Year last visit dentist *

    Reason leaving current dentist

    Any specific wishes

    How did you find us?

    I agree with the 

    Tandartsenpraktijk Den Haag

    First appointment

    Please bring your ID when you come to our practice. You will also need to fill out a one-time medical questionnaire. If you are taking any medication, would you please list the name and dosage?

    Recent X-rays are necessary to get a good impression of your teeth. If these X-rays are older than two years, of poor quality or missing, they will be redone. In some cases it is necessary to make an additional X-ray of a specific area. You will be informed in advance if this is the case. After the initial consultation, you will have become a patient in our practice.

    Contact Information ▼

    Dental Practice Hollands Spoor
    Stationsweg 107 1st floor
    2515BL The Hague

    Dentist P. Grewe      (070) 3800910
    Dentist D.R. Kösters (070) 3802891

    Opening Hours ▼

    Dentist Paula Grewe
    Monday to Thursday 8.30 – 17.00
    appointment | register

    Dentist Derk Kösters
    Monday to Thursday 8.30 – 17.00
    appointment | register

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