Registration form

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 below. 

Be aware that filling out the form does not automatically lead to a registration with our GP practice. Since demand is very high, we are not able to fullfill all requests. Final registration will only take place after we have contacted you and after a clinical intake when necessary. If you need immediate care please call SMASH/HAdoks: 070 346 96 69

This page was last updated in June 2020. 

 

indicates a required field

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.
Would you like to stay up-to-date and receive our quaterly newsletter?

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.


 IHCH Code of Conduct 

Subscribe to our newsletter & stay updated
Share: