TO REGISTER

Would you like to enjoy our expert care and pampering during your maternity period? Our dedicated maternity assistants would love to look after you! Fill in your details here. We will send you a written confirmation of your registration within three days. You can’t make head or tail of it? Just give us a ring on 088 – 11 67 900.

Initials
Maiden name
Partner's surname
Date of birth
BSN (citizen service number)
Address
Postal code
Town/city
Phone number
Phone number partner
Email address
Nationality
Spoken language
Healthcare insurance company
Healthcare insurance number
Midwifery practice
Place delivery (home/hospital)
Name hospital (home/hospital)
Due date of birth
How many pregnancies?
Previous children; name, gender, date of birth
Particulars

I agree to the General Terms of Delivery

Have you checked the General Terms of Delivery yet?

We’ll always send you a confirmation of your registration within three days.