Registration Form

IMPORTANT MESSAGE:

Due to the high number of new registrations with our GP section the waiting times for consultations  with our GP's are longer then we consider acceptable for our existing clients.  Therefore we apply a temporary stop to new registrations till the waiting times have become in line with our quality standards. Registrations for our polyclinic, dentistry and pharmacy will be continued.

You can leave your email adress if you would like to be informed when the patient stop has ended.

Your primary residence (home address)

Other family members

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

Registration & appointment

Booked appointment
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 and agree to the terms and conditions on the IHCH website and in the IHCH Code of Conduct. I/we also agree to be a registered patient(s) at the IHCH located at Jan van Nassaustraat 125, 2596BS The Hague

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