Studenten may register by filling in this form:

Are you a student and are you living in Groningen or are you going to move here in the near future? Fill in this form to register in our general practice.

If you prefer to have an appointment for an acquaintance, call our assistent on 050-3127228.

Fields marked with (*) are required!

Surname: (*)
Initial(s): (*)
First name:
Gender: Male Female

Address: (*)

Postcode (ZIP code): (*)
City: (*)
Telephone number: (*)

E-mail address: (*)

Date of birth: (*)
Burger Service Nummer (Dutch Social Security Number):

Health insurance company: (*)

Health insurance card number: (*)
Pharmacy (if you already picked one):

Educational institution: (*)

Your study/programme: (*)

Hereby you agree to be registered with
General Practitioner huisartsenpraktijk Radesingel: (*)

Yes, I agree

Possible remarks:
 

On your e-mail adress, you will receive a copy of your registration automatically.