Register

1/3 Personal data:

First and last name *

Date of birth *

Street + house number *

Postal Code *

City

Telephone number

Mobiel*

Email*

2/3 Additional information:

Current GP

How many pregnancies

Any previous pregnancies guided by us?
YesNo

Date of birth of the youngest child and / or miscarriage

Contraception used until

Type of contraceptive

Average cycle time

First day of last menstrual period

Date of positive pregnancy test

3/3 Make an appointment

The first appointment takes place at 8 to 10 weeks of pregnancy.
Our assistant will make an appointment with you. Please indicate below when our assistant can reach you.