Registration Form

Please complete the following form and press the send button below. We will further contact you to plan the first appointment for an intake at our clinic.

Please also be informed that you need to bring your legitimation card (Passport, Dutch Driving License or other ID-card).

During the intake, a consultation with the dentist will take place and x-rays photos will be taken. The dentist will examine your oral health and consult any possible oral problems. New x-ray photos are not necessary to be taken if your previous x-ray photos are not older than 6 months. Please ask your previous dentist to send these photos to lach@mondzorgdudokplein.nl before your intake appointment.

For your intake appointment, it will cost approximately around €150,00 per person above 18 years old (included the x-ray photos).

You are completely registered at our clinic after your first visit for the intake with the dentist.

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