Referral 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 appropiate specialist for your condition.

Please fill out the form below to request a referral to a specialist. After completion and submission of the form, one of our medical staff will get in contact with you within 2 working days, between 12pm and 1pm.

Please note that all information is treated confidentially and is GDPR compliant.

Requesting a referral does not mean your referral is automatically granted.

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