Application


Form

If you would like to register your child for diagnostic examination or treatment, we kindly ask you to fill out the form below as complete as possible. This allows us to arrange the right funding you’re your municipality. We will contact you as soon as possible. 
Please be aware that Kinderpraktijk Uithoorn will be (partially) closed during the school holidays aligned with region North.


Aanmeldformulier

Diagnostic research
Treatment
Other
I don't know
Anxiety
Anger / agression
Trauma
Social problems
Learning problems
Sadness / depression
Other
Yes, I have read and accept the privacy policy
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