Register Students - JANS Huisartsen

Register

Complete the form below to register at Jans Huisartsen Kralingen.

At the moment we are closed for registrations, we will open soon.

BSN*
What kind of insurance do you have:*
Educational institution*
Student number*
Name*
First name Last name
Gender*
Date of Birth*
Day
Month
Year
Address*
Email address*
Phone*
Practice*
Extra AON ICS complete+ information
Extra European Health insurance card (EHIC) information
Extra information
Extra Insured to Study information
Identification number of the card*
Expiry date*
Year
Month
Day
Upload your insurance card (front)*
Toegestane bestandstypen: jpg, png, pdf, Max. bestandsgrootte: 5 MB.
Upload your insurance card (back - if applicable)
Toegestane bestandstypen: jpg, png, pdf, Max. bestandsgrootte: 5 MB.
Akkoord*
- I agree to register with Jans Huisartsen
*
- I agree that Jans Huisartsen processes my data that is required for registration.