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Klinic, your health we care

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WhatsApp / Mobile 信息/电话联络: +31 611361099

营业时间：周一至周四：9:00 - 17:00

诊所地址： Oude Waal 6H, 1011 BX Amsterdam

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请填写以下表格,

我们会尽快与您联系。

Request an appointment

请填写以下表格,

我们会尽快与您联系。

快速预约表

名*

姓*

电子邮件*

电话号码*

您希望多快可以见到医生？*

您有偏好的医生吗？*

首选日期和时间段*

Quick

如果您尚未注册成为Klinic的患者，请您在首次就诊前填写注册表格。此过程大约需要10分钟。感谢您的配合。

New Registration

New Patient Registration

Please complete all required fields before continuing. * is Required

Personal Information:

First + Last name*

Gender *

Male

Female

Prefer not to say

Country of Birth*

Birthday*

年

月

天

Marriage status*

Married

Partnership

Single

Prefer not to say

Your address: House number + post code + city*

Phone*

Email*

Amount of children*

0

1

2

More

Profession *

Full name of your General practitioner *

Address of your General Practitioner*

Your insurance & customer number*

KvK registration: Amsterdam 34295824

chinesemedicine.klinic@gmail.com

电话：+31 611361099

隐私政策

地址：Oude Waal 6H, 1011 BX Amsterdam，荷兰。

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