New patient registration form

We appreciate your registration as a patient with Dental Care Utrecht. Please fill out the form below and click ‘send’. A member of our team will contact you as soon as possible for an appointment. If you prefer, you can also call us at 030 – 252 03 59. 

Dutch registration form / Nederlands inschrijfformulier 
Voor ons Nederlandstalige inschrijfformulier klikt u hier.

Medical history
At your first appointment you will be asked to inform us about your medical history so we can take the right precautions if necessary. It is also important to keep us informed about any changes in your medical condition or status.