University Doctors Office registration form

Personal details

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    No
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  5. Male Female
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Residential address

    Residential address, if different from the address on your healthcare insurance policy:

Your insurance

Types of registration

There are several options for registration as described below. Please choose the form of registration applicable to you.

Regular patient with the University Doctors
In this case you register with the University Doctors / 'Oude Turfmarkt' GP's office as a regular, or permanent, patient. The University Doctors normally submit all expense claims directly to the healthcare insurer. Please note that this is only possible if you possess a BSN (Citizen service number) and a Dutch Health Insurance. If you possess an insurance like AON or CIGNA, you will be categorized as a temporary patient.

Temporary patient with the University Doctors
In this case you register with the University Doctors as a so-called 'temporary patient'. This means you must submit expense claims to your healthcare insurer yourself. Please note, however, that you can only choose this option if the address at which you are registered with your healthcare insurer is outside Amsterdam (for example, that of your parents). If you are registered with your healthcare insurer as resident in Amsterdam, then by law you are required to register as a permanent patient with a GP in Amsterdam.

  1. Regular patient with the University Doctors
    Temporary patient with the University Doctors

Authorisation

Authorisation to give notice of termination to previous GP

You can authorise the University Doctors to terminate your registration as a patient with your previous GP and request your medical file to be sent to the University Doctors / 'Oude Turfmarkt' GPs in Amsterdam.

Confirmation