Students, PhD-students and recent graduates may register by filling in this form:

Are you a student, PhD-student or recently graduated 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: (*)
Place of birth: (*)
Country of birth: (*)

BSN (Dutch Social Security Number):
I don't have a BSN

Health insurance company:
Health insurance card number:
I don't have a dutch health insurance

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 (*)
Your former dutch GP (if applicable):

Possible remarks:
 

On your e-mail adress, you will receive a copy of your registration automatically. If not, check your SPAM box.

If you encounter any problems during registration, just call the practice: 050-3127228.