Registration form – Psyche & Zwangerschap

Clients can only register for treatment by completing the registration form below.

The waiting list is currently approximately 10 weeks. Merith Cohen de Lara doen’t take new clients.

Applications are processed three times a week. After processing your application, you will be contacted by telephone or e-mail.
PLEASE NOTE: From 1 to 13 August applications will be processed less often. Therefore you will be contacted at a later time. For urgent questions, please send an email to info@psychezwangerschap.nl.

Contract-free psychologists often do not have a waiting list at all. At least half of the basic mental health care is generally reimbursed, regardless of what policy you have. Read more about rates and Insurers >>.

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.
Referrer*
Insurer:*
Comments or questions:
Phone
This field is for validation purposes and should be left unchanged.