Pret in herstel

Personal information

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Intersertion

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Surname(*)

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Date of birth(*)

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Place of birth(*)

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Country of birth(*)

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Sex (*)

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Social Security Number (BSN)(*)

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Contact details

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House number(*)

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Addition

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Zipcode(*)

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City(*)

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E-mail adress(*)

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Phone number

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Mobile number

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Clinic of origin

Who did you refer to?

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Naam referrer

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Therapy

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Cleandate

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Dismissal date

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Kliniek van herkomst

Name clinic

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Name referrer

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E-mail referrer / practitioner

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City of origin

Name of the City where you lived before you went to the clinic

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Street

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Zipcode

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House number

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City

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Addition

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WMO

Has a WMO been reported?

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If yes, where?

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When?

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Pih Intake

Bordewijklaan 38
2591XR The Hague
intake@pretinherstel.nl
Tel: +31 (0)70 8875874

Pih General

Bordewijklaan 38
2591XR The Hague
info@pretinherstel.nl
Tel: +31(0) 70 7920057

Pih Administration

Bordewijklaan 38
2591XR The Hague
administratie@pretinherstel.nl
Tel: +31 (0)70 7920362

Pih Coaching

Laan van Meerdervoort 178
2517 BH The Hague
ambulant@pretinherstel.nl
+31 (0)70 792 0096

Pih Delft

Oude Delft 169
2611 HB Delft
delft@pretinherstel.nl
+31 (0)15 792 0021

Pih The Hague

Laan van Meerdervoort 170
2517 BH The Hague
denhaag@pretinherstel.nl
+31 (0)70 369 8664

Pih Wateringen

Julialaan 4
2291 BM Wateringen
wateringen@pretinherstel.nl
+31 (0)174 705 127

Billing Information

Chamber of Commerce:
54067316

Bank Number:
NL56RABO 0152 70 57 59

VAT Number:
851143544B01