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Birth in Holland

Birth in Holland

Building confidence for a better start for your family

  • Pregnancy Services
    • Midwifery Services
      • Registration for midwifery care
      • Contraception
    • Doula Services
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    • Courses overview
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Registration for midwifery care

Registration form

Personal details

Name(Required)
Initials(Required)
Maiden name (if applicable)
Address(Required)
Date of birth(Required)
Country of birth
Marital status

Religion

Highest level of qualification achieved
Apotheek
Are you registered with the Reinier de Graaf hospital?

Partner's details

Name
Date of birth
Highest level of qualification achieved
Does your partner have children from a previous relationship?

Pregnancy details

DD slash MM slash YYYY
number of days between periods (eg. 28)
Were you using contraception before your pregnancy?
DD slash MM slash YYYY
Result
DD slash MM slash YYYY
if you have done one
Result
Have you received any form of fertility treatment?
treatment type, dates and health care provider
What number pregnancy is this for you?
This field is for validation purposes and should be left unchanged.

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Birth in Holland
Gerbrandylaan 36
2625LR Delft

info@birthinholland.com

KVK: 67260896
AGB code: 0800/3339
BTW: 856900990B01

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Birth in Holland

Providing courses, pregnancy & birth services for international families.

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