Register as a new patient

By using the form below you can sign up as a patient at the Academische Huisartsenpraktijk Groningen.
After you have submitted the form, you will be contacted. Make sure you fully fill in the form with correct data given!

Register as a new patient

Personal data

Choose Day (Dag), Month (Maand) and Year (Jaar)
Please enter your Dutch burgerservicenummer if you have registered in the Personal Records Database and otherwise enter your personal identification mark and select your identification document.

Contact information


Insurance information

4 digits number.

Address on Insurance policy

Is your adress on your insurance policy not the same as your residential address, would you indicate this below?

Previous practitioner

National Switch Point (LSP)

As a practice, we are affiliated with the National Switch Point (LSP). If you give permission, other healthcare providers will have reliable access to part of your medical information. For more information about the LSP we refer to the website