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About us
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Register

Start
About us
For patients
Dental care
Q & A
Contact US
Register

Register as patient

Are you looking for a high quality, transparent english speaking dentist in Amstelveen or dental hygienist? You are welcome as a new client to our practice. Please fill in the form on this page, one of our english speaking receptionists will contact you soon to schedule your first appointment. You can also call us directly by phone at 020-34 51 534 to register as patient.

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Registration Form

Once we received your registration form, reception will contact you to inform you if there is no waiting list. Reception will schedule an intake appointment with one of our dentist.

Firstname*
Lastname*
Birthdate*
Date Format: DD dash MM dash YYYY
Postalcode*
Housenumber*
Emailaddress*
Phonenumber*
Gender*
- Man
- Female

When was your last dental check-up?*
Previous dentist practice?*
Any dental complaints | Dental wishes?

Tevens inschrijven
- Register Partner
- Register my children
number of children:
Partner

Firstname*
Lastname*
Birthdate*
Date Format: DD dash MM dash YYYY
Postalcode*
Housenumber*
Phonenumber*
Emailaddress*
Gender*
- Man
- Female

When was your last dental check-up?*
Previous dentist practice?*
Any dental complaints | Dental wishes?

Children

Firstname*
Lastname*
Birthdate*
Date Format: DD dash MM dash YYYY
Gender*
- Man
- Female

Firstname*
Lastname*
Birthdate*
Date Format: DD dash MM dash YYYY
Gender*
- Man
- Female

Firstname*
Lastname*
Birthdate*
Date Format: DD dash MM dash YYYY
Gender*
- Man
- Female

Firstname*
Lastname*
Birthdate*
Date Format: DD dash MM dash YYYY
Gender*
- Man
- Female

Firstname*
Lastname*
Birthdate*
Date Format: DD dash MM dash YYYY
Gender*
- Man
- Female
Comments
This field is for validation purposes and should be left unchanged.

Contact Us

Anny questions? Don’t hesitate to call us.

Send us a message

THE PRACTICE

Keizer Karelpark Tandartsen

Lindepark 2A

1185LD, Amstelveen

020 - 34 51 534

info@tandartskeizerkarelpark.nl

About us
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Dental care

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Register

Dentist Amstelveen Westwijk
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