Information for referrers
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. You'll receive a response from us within 5 days.
Questions or problems applying?
Please email us at
What is your name?
What is your date of birth?
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?
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.
Greek (Groningen only)
Papiamento (Amsterdam only)
Do you have a Dutch BSN number?
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
How are you insured for healthcare costs?
I have a Dutch healthcare insurance.
I am only insured by the NHS
I have more than one healthcare insurance.
I'm not sure / other
What is the name of your healthcare insurer?
How did you find Empower? (optional)
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