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Online REGISTRATION

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REGISTRATION

You can now complete this form online. You will receive a confirmation of your registration by email within three workdays. We would also like to invite you for an introductory appointment with the general practitioner (GP).

We kindly ask you to inform your former GP about your registration at our practice. As part of the processing of your registration, we will ask your former GP to send us your medical file. These data will be sent electronically.

ONLINE FORM

Required *

INFORMATION

Choose a pharmacist

The undersigned hereby declares that the following person is registered as a patient at Swijgman General Practice Office in Maastricht and consents to have medical information recorded in the practice's electronic medical record. Fill in your name, date of birth and sex. We use a secured connection for this information: your information is only accessible to treatment providers at Swijgman General Practice Office. We also provide the pharmacist of your choice with your name, address, list of household members and medications.