Register location Bergschenhoek - Tandent - Kliniek van Tandheelkunde

Would you like to become a patient at Tandent Location Bergschenhoek?

We are accepting in Bergschenhoek yet clients. If interested, please fill out the registration form and we will contact you as soon as possible.

Fill out the form below or contact us.

Last name

Initials

First name

Birthdate

Gender

Man Woman

BSN / Social security number

Streetname and house number

Addition

Postal code

Residence

Home phone number

Work phone number

Mobile

Email address

If you are visiting the practice for the first time, please always bring your insurance card.

Name of your insurer

Policy number

Insurance start date

Date of your last dental visit

What are your dental requirements

Important data / Notes

We only use personal data you provide to give you the best possible service. See also our privacy statement. By pressing send you agree to this.