Registration practice We are currently closed to new patients. An exception is made for extending the family relationship, such as cohabitation with an already registered patient and newly born babies. * = verplicht veld First name* Surname* Gender* m v Date of birth* Day Month Year Insurance* Insurance number* Did you get the flu shot from your previous doctor? If so, for what reason?* ja nee Reason if flu shot received Street* House number* Addition Postal Code* Citizen service number* Phone number*E-mailadress* Name of previous GP* City of previous GP* RemarksPermission* I hereby confirm my registration with Huisarts aan de Herengracht and I give them permission to deregister me and to request my medical data from my previous GP.