TO REGISTER Become a patient at Fonkelzorg Enter your details below. We’ll let you know soon when you can visit the location that suits you best. Registration form Practice(Vereist)Fonkelzorg Den Bosch - Locatie Antonius (Centrum)Fonkelzorg Den Bosch - Locatie San Salvator (Orthen/Noord)Fonkelzorg EindhovenFonkelzorg OssFonkelzorg UdenWerkgebied: Great that you want to register! 😀 We are accepting patients from Uden and the Maashorst area. Patients from Boekel or Veghel unfortunately fall outside our service area. 😬Registration date(Vereist)Per directPer onderstaande datumRegistration date (if not immediately) DD dash MM dash JJJJ Firstname(Vereist)Initials(Vereist)Lastname(Vereist)Date of birth(Vereist) MM slash DD slash JJJJ Gender(Vereist)MaleFemaleOtherAdres(Vereist)Postcode(Vereist)Phone number(Vereist)E-mailadres(Vereist) BSN-number (Dutch social security number)Identity document(Vereist)PassportID CardResidence permitIdentity document number(Vereist)Insurance company(Vereist)AON policy numberGet access to the 'National Exchange Point' or LSP(Vereist)YesNoDon't want to answerPrior General Practitioner (if available)New pharmacy (if known)Acceptance Fonkelzorg will officially register you as a patient at the practice above. You've read and are familiar with the houserules of the practice. Yes! 🙂
