Registration form – Psyche & Zwangerschap

Clients can only register for treatment by completing the registration form below. Referrers can fill in the registration form together with their client.

No guarantee can be derived from the waiting times stated below.

For an online treatment with an English speaking psychologist (contract with Achmea and contract-free) the waiting time is about 12 weeks.

The waiting time for a face to face treatment with an English speaking psychologist with no contracts is at least 16 weeks (www.contractvrijepsycholoog.nl).

The waiting list for a face to face treatment with an English speaking contracted psychologist is at least 12 months.

If you need urgent help, please contact your doctor. Or perhaps Arkin or inGeest can see you sooner.

After processing your application, you will be contacted by e-mail within three days. For urgent questions, please send an email to info@psychezwangerschap.nl.

Please use this form to register with one of our therapists. Fill in the form as completely as possible. The fields marked with an asterisk are obligatory.

Name*
Name Surname
(Mobile) Phone*
E-mail:*
Choose your therapist*
Choose your therapist from the list. If you have no preference choose 'Secretary'. You will then be assigned to the first available therapist.
Are you open to online treatments?*
- Yes, I am open to online treatments
- No, I only want face-to-face treatments
- I have no preference, I like both treatments
Prefered place for treatment (only at face to face appointments)
We would like to know why you need our help:
- Pregnancy
- Post partum
- Fertility
Referrer*
Insurer:*
What kind of policy do you have with your insurer?*
Comments or questions:
What is the color of fresh snow?*

This question is asked you to identify you as a real person. In the case you can not send the form after answering the question please connect us by e-mail: info@psychezwangerschap.nl
Comments
This field is for validation purposes and should be left unchanged.