Registration form waiting roomEnglish - Medisch Centrum Voor Dieren

Details of your veterinary practice*
Is your vet not listed? Then click here
- Is your vet not listed? Then click here
Name of veterinary practice*
Address vet
Street City State Zipcode Country
Are You under financial guardianship?*
- Yes
- No
Name of administrators company*
Name of financial administrator*
Address of administrators office*
Street Address City State / Province / Region ZIP / Postal Code Country
Site link for administrators office*
Consent general terms and conditions*
I agree to the Terms and Conditions*
The General Terms and Conditions of the Royal Dutch Society for Veterinary Medicine, filed with the registry of the district court in Utrecht under number 22/2008, apply to (treatment) agreements.
Consent Privacy Terms*
I agree with the privacy conditions*
The above data is requested for optimal treatment of the patient. If you would like to see exactly what the data is used for, we refer to the privacy statement on our website. You can request a paper version at the desk.
CAPTCHA
Signature*