Referral consultation request form

In the Netherlands you need a referral letter before you can book an appointment with a specialist. In addition, Dutch insurances won’t cover the costs of seeing a specialist without a referral. In most cases, it will be your GP referring you to a specialist. This also ensures that you are referred to the most appropriate specialist for your condition.

When requesting a referral from your GP for a medical specialist, please note the following:

  • Please do not book an appointment with a specialist before having an appointment with a GP,  referrals can not be granted in these cases.
  • This form is a call back request to discuss a referral, it does not mean that a referral is automatically granted.
  • Note that this service is equal to a consultation with the GP and you will therefore be billed for a GP consultation.

Please fill out the form below to request a telephone consultation with our GP for referral to a specialist. After completion and submission of the form, one of our medical staff will call you  from our general phone line (070 306 5100) within 2 working days, between 12pm and 1pm. All information is treated confidentially and is GDPR compliant.


Sometimes a specification for referral is needed, If you leave this field blank, our medical staff will ask for this during the call-back.