Registration form

Registration form

Important:

Due to the long waiting lists within speech therapy, we will apply a (temporary) zip code policy.

Currently we have a waiting list of about 0-3 months.

After filling in the form, you will receive a confirmation. Did you not receive an e-mail, please check your spam-folder.

Fill in the form below with the details of the person you are registering.

Aanmeldformulier ENGELS
Gender *
Preferred days *
Do you have a referral letter?