Referral & patient registration
Dear referring colleagues, thank you for your trust.
Ways to refer a patient
For a smooth patient registration, you can use our referral form. You can either fill it in conveniently below and have an e-mail created directly to send by HIN-Mail. Alternatively, download it as a PDF and send it by HIN-Mail, post or fax. Or simply copy the text and include it, for example, in your report, which you can send to us by HIN-Mail, post or fax. The blank PDF form can also be downloaded and saved locally so you can create a referral at any time. Of course, you are also welcome to send us a referral by any other means.
How a referral works
After receiving your referral, we contact your patient promptly to arrange an appointment. Following the consultation and any treatment, you receive a report via your preferred channel (HIN-Mail, fax or post). In urgent cases, you can reach us by HIN-Mail or are welcome to call us directly — we will try to offer a solution the same day.
Contact for referrals
Online referral
Fill in the fields and create a ready-to-send e-mail or a completed PDF directly from them. No data is transmitted to a server.
Alternative: the classic PDF form
You can also download the referral as a PDF, fill it in and send it to us in the usual way.
Save the PDF
Download the referral form as a PDF and save it locally on your computer.
Fill in the form
Open the PDF in a PDF reader and fill in the fields with the patient data and clinical information.
Send the form
Send the completed form to our practice by HIN-Mail, fax or post.