Registration form

New patient

If you wish to become a patient in our practice, there are some things I would like to bring to your attention.

In our practice, we strive for quality. The most important thing is your oral care at home. Without good oral hygiene by yourself, gum and jaw bone inflammation and of course tooth decay (cavities) will occur.
For this reason, we ask our patients to make a maximum effort concerning oral hygiene at home. Without this, we can’t guarantee high quality.
Of course, we will advise and guide you in this matter.

To let our contact run smoothly and efficiently we would like to draw your attention to the “practice rules”.

  • Check-ups are carried out in consultation with the dentist once or twice a year.
  • Following this, treatment appointments are made.
  • We aim to make an appointment for your next check-up immediately.
  • You are responsible for your appointment. If you are unable to keep your appointment, please cancel at least 24 hours in advance on working days (or leave a message on our answering machine). Otherwise, we are forced to charge for the scheduled time.

To make appointments, please call us at the following times:

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Monday
09.00 – 12.00
13.00 – 17.00
Tuesday
09.00 – 12.00
13.00 – 17.00
Wednesday
09.00 – 12.00
13.00 – 17.00
Thursday
09.00 – 12.00
13.00 – 17.00
Friday
09.00 – 12.00

The dental rates are set by the Dutch Health Care Authority (NZa). Health insurance companies refer to the document with the dental rates as the policy rule Dental Care of the Dutch Health Care Authority.
In my practice, I work with an intake consultation for new patients, for which I plan plenty of time. This way we get the fullest possible picture of the patient, the mouth, and the wishes of each individual. Therefore you can count on the following costs.

Actions

We will contact you as soon as we have received the attached questionnaire.

If there is room for new patients, we can schedule you for an intake consultation. We may have to put you on a waiting list. If this is the case, you will be informed about this upon receipt of your registration form. As soon as there is room for new patients, we will contact you to make an intake appointment. To register as a new patient, we request that you complete a registration form. You can do this via this link. To obtain the form you can send an email to info@whitesmile.nl with the subject “registration form”. Of course you can also request a registration form by telephone on 040-2544544.

Don’t forget to let your previous dentist know about your switch, cancel your scheduled appointments and ask for your dental information to be sent to us.

We request that patients who have not been remediated should take into account that the treatments must be paid in cash until remediation.

Operation
Code
Price
* Depending on the case and the time spent, code C11 or C28 will be charged. The costs amount to min € 22.91 and max € 108.52. Provided that you have supplementary dental insurance, In most cases, these costs will be reimbursed by your health insurer. We advise you to Please check with your health insurer. The intake consultations may lead to a discussion of the treatment plan, Depending on the time spent, costs will be charged.
Intake consultation / examination c.q. treatment plan discussion
C11 / C28
Starts with € 22,91*
Medical anamnesis
C22
€ 22,91
OPT photo
X21
€ 72,35
Bite picture 2x (if needed)
X10
€ 16,88/stuk
Tartar per unit of 5 min (if needed)
M03
€ 13,52
Instruction in oral hygiene or dietary advice per unit of 5 min.
M01
€ 13,52

Become a new patient? Fill in the registration form

Registration form

We will contact you as soon as we receive the attached questionnaire.

We will contact you as soon as we receive the attached questionnaire.

If we have room for new patients, we may schedule you for an intake consultation. We can put you on a waiting list. If this is the case, you will be informed after receipt of your registration form. As soon as there is room for new patients, we will contact you to make an intake appointment. To register as a new patient, please fill in a registration form. You can do this via this link. To obtain the form, please send an email to info@whitesmile.nl with the subject “registration form”. Of course, you can also request a registration form by phone at 040-2544544.

Please remember to inform your previous dentist about your change, cancel your scheduled appointments and ask for your dental records to be sent to us.

We request that non-cleared patients take into account that until the treatment has been cleaned up, all payments should be made in cash.

 

Best regards,

Dentist R. Strijkert