Make an appointment at StatenClinic

To make an appointment, you can either

Call us at +31 70 322 0920 (see also 'Contact') or:
You can submit the web form below and we will contact you asap.

Mr./Mrs. *

First Name and Family Name *

Date of Birth *

Address *

Post code and City *

Country

Mobile/Land Line *

Email

Name of Dutch health insurance (fill in "foreign" if not applicable) *

General practitioner (only for patients insured in The Netherlands)

BSN (SoFi) - at your discretion

Appointment with dermatologist Mrs Priv.-Doz. Dr. med. M. Placzek-Neukirchen

Appointment for laser therapy

Appointment for medical skin therapy

Remarks

Yes, I give permission to StatenClinic for the use of my (medical) personal data for the purpose of making an appointment and creating a record in the digital patient file of StatenClinic. The privacy statement explains in which way this happens. *

Please enter the fields marked by *, because this will facilitate registering for an appointment. We will call you or send you a mail as quick as possible.

When you visit us for the first time, please bring with you either your ID card, or your passport, together with your insurance card. In case you are insured in the dutch health care system you'd need a referral of your general practitioner.

For all consultations and treatments we will ask you to pay the total amount of your invoice within the given time limit, once you have received the invoice. You can submit the invoice for reimbursement to your health insurance company. You’ll find additional information here.