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Statenkliniek Dermatology
WGBO

Statenkliniek

According to the law (WGBO) you are entitled to receive your medical data. Please fill in the form below to request your file.

First Name + Lastname *

Date of Birth *

Your Email *

Any other Remarks *

I want my medical dossier to be deleted

I ask for my medical dossier to be sent to me via e-mail

I have selected at least one of the two check boxes above *

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