Registration form

* indicates a required field

Please read the IHCH Code of Conduct before you proceed

If you have an acute medical problem you can go to MCH hospital,

Address: Lijnbaan 32, 2512 VA Den Haag

 

Please fill out the registration form underneath. 

Your registration is conditional until you receive an email with confirmation of your registration, or with a notification that you are put on a temporary waiting list , due to a large number of registration requests at the moment.

Your primary residence (home address)

Other family members registering

Family member #1
Family member #2
Family member #3
Family member #4
Family member #5

Medical condition(s)

I need medical care quickly (within 3 weeks)
Will you be bringing a referral letter with you?
(Necessary if you have an appointment with a specialist, are registered with a GP elsewhere and have Dutch insurance)
Please upload your referral letter, if any (as a scan, PDF or good photo with your phone).
Please indicate here if you are changing insurance provider, address, have a special request or would like to leave a comment.

By submitting this form, I/we understand that an appointment can and will be offered only after I have received a confirmation by e-mail or telephone that I have been accepted as an IHCH client.



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