Head of the family


    Mr.Mrs.


    Address








    Partner


    YesNo


    Children


    YesNo


    Some questions





    Conditions

    I have read and agree to the general terms and conditions of Beekmans Tandartsen, including the cancellation and protection of personal data below:

    Cancellation terms and conditions
    Appointments that are rescheduled or cancelled by the patient for whatever reason must be communicated to us at least 48 hours in advance during office hours, preferably by telephone. If you do not notify us in time, we will charge you for the cost of the lost time.

    Protection of personal data
    I allow my personal data, images, results and/or models to be shared with third parties. These are colleagues, dental technicians, health insurers and government agencies. My data may also be used anonymously for research, publications, accreditations, lectures, own website and patient information.

    Registration

    Beekmans Dental Practice