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Referrers
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Apply here
Do you or does someone else require immediate attention? Call the Dutch emergency number 112, your general practitioner or after business hours the "huisartsenpost" in your city.
Fill in the form below to apply for a non-committal introductory meeting. We will then contact you soon to schedule the meeting.
If you have any questions, please email us at
support@empower-pt.nl
.
What is your full name?
*
What is your date of birth?
*
DD
MM
YYYY
What is your email address?
*
What is your phone number?
*
Include your international prefix if necessary.
In which city would you like to have therapy?
*
Amsterdam
Groningen
In which language would you like to have therapy?
*
You can select multiple languages. We may be able to help you sooner if you select more than 1 language.
English
Dutch
German
Do you have a Dutch BSN number?
*
Yes
No
What is your Dutch BSN number?
*
Do you already have a referral letter?
*
In case you have a referral letter, please send a scan or photo to us at
support@empower-pt.nl
.
Yes
No
How are you insured for healthcare costs?
*
I have Aon Student insurance.
I have a Dutch healthcare insurance.
I have a healthcare insurance from the UK.
I have a foreign healthcare insurance (all other countries).
I don't have healthcare insurance.
I have more than one healthcare insurance.
I'm not sure.
I'd like to pay myself.
What is the name of your healthcare insurer?
*
Comments (optional)
How did you find Empower? (optional)
Apply now
Referrers
Waiting time
About us
Practices
Contact
Therapy
Problems
Procedure
Reimbursement
www.empower-pt.nl/en/apply-here/
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