{"id":27857,"date":"2019-07-08T18:13:17","date_gmt":"2019-07-08T16:13:17","guid":{"rendered":"https:\/\/yourdental.nl\/register\/"},"modified":"2026-03-22T13:07:22","modified_gmt":"2026-03-22T12:07:22","slug":"register","status":"publish","type":"page","link":"https:\/\/yourdental.nl\/en\/register\/","title":{"rendered":"Register"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><section class=\"l-section wpb_row height_medium with_overlay\"><div class=\"l-section-overlay\" style=\"background: #e26c66\"><\/div><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_top\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"w-separator size_custom\" style=\"height:2rem;\"><\/div><h1 class=\"w-page-title align_center\" itemprop=\"headline\" style=\"font-family:&#039;Poppins&#039;, sans-serif;color:#ffffff;\">Register<\/h1><div class=\"w-separator size_custom\" style=\"height:2rem;\"><\/div><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_small\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_top\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><ol class=\"g-breadcrumbs separator_icon align_left\" itemscope itemtype=\"http:\/\/schema.org\/BreadcrumbList\"><li class=\"g-breadcrumbs-item\" itemprop=\"itemListElement\" itemscope itemtype=\"http:\/\/schema.org\/ListItem\"><a itemprop=\"item\" href=\"https:\/\/yourdental.nl\/en\/\"><span itemprop=\"name\">Home<\/span><\/a><meta itemprop=\"position\" content=\"1\"\/><\/li><li class=\"g-breadcrumbs-separator\"><i class=\"far fa-angle-right\"><\/i><\/li><li class=\"g-breadcrumbs-item\">Pages<\/li><\/ol><\/div><\/div><\/div><\/div><\/div><\/section><section class=\"l-section wpb_row height_medium\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_top\"><div class=\"vc_col-sm-4 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\r\n\t<div class=\"wpb_text_column \">\r\n\t\t<div class=\"wpb_wrapper\">\r\n\t\t\t<h2>Register as a new patient?<\/h2>\n<p>Would you like to register as a patient at the Your Dental oral care practice? You can do so by completing the contact form on this page. Once we have received your form, we will contact you as soon as possible to schedule an initial appointment.  <\/p>\n<p><a href=\"#formulier\">Click here for the registration form<\/a><\/p>\n<p>New patients are required to complete a questionnaire during their first visit to the practice. This list includes questions regarding address details and health. You must also be able to identify yourself with a legal form of identification and present an insurance card.  <\/p>\n<p>Should you have any questions prior to your first appointment, regarding the forms, or about a treatment, you can always call us from Monday to Saturday at <a href=\"tel:0368419675\">036-8419675<\/a>. <a href=\"https:\/\/yourdental.nl\/#openingstijden\">View our current opening hours here<\/a>. If you are unable to call, you may also send an email to <a href=\"mailto:balie@yourdental.nl\">balie@yourdental.nl<\/a>; one of our staff members will answer your question as soon as possible.<\/p>\n\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div><\/div><\/div><div class=\"vc_col-sm-8 wpb_column vc_column_container\" id=\"formulier\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f27912-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"27912\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/27857#wpcf7-f27912-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"27912\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f27912-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"cf7-inputs cf\">\n\t<div class=\"one-fourth first\">\n\t\t<p><label>Initials <small>(optional)<\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-initials\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Your initials\" value=\"\" type=\"text\" name=\"afspraak-initials\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"three-eighth\">\n\t\t<p><label>First name <small> (required) <\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your first name\" value=\"\" type=\"text\" name=\"afspraak-firstname\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"three-eighth last\">\n\t\t<p><label>Last name <small> (required) <\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-lastname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your last name\" value=\"\" type=\"text\" name=\"afspraak-lastname\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-fourth first\">\n\t\t<p>Gender <small>(optional)<\/small><span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-geslacht\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"afspraak-geslacht\" value=\"Male\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"afspraak-geslacht\" value=\"Female\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"afspraak-geslacht\" value=\"Other\" \/><span class=\"wpcf7-list-item-label\">Other<\/span><\/span><\/span><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"three-eighth\">\n\t\t<p><label>Email address <small> (required) <\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"A valid email address\" value=\"\" type=\"email\" name=\"afspraak-email\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"three-eighth last\">\n\t\t<p><label>Phone number <small> (required) <\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Your phone number\" value=\"\" type=\"text\" name=\"afspraak-phone\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"fullwidth\">\n\t\t<p><label>Address <small> (required) <\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your address and house number\" value=\"\" type=\"text\" name=\"afspraak-address\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-third\">\n\t\t<p><label>Postcode <small> (required) <\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-zipcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your postcode\" value=\"\" type=\"text\" name=\"afspraak-zipcode\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"two-third last\">\n\t\t<p><label>City <small> (required) <\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your city\" value=\"\" type=\"text\" name=\"afspraak-city\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"fullwidth\">\n\t\t<p><label>Date of birth (dd\/mm\/yyyy) <small> (required) <\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-birthdate\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Your date of birth\" value=\"\" type=\"text\" name=\"afspraak-birthdate\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<h2>I would like to make an appointment\n\t<\/h2>\n\t<div class=\"two-third\">\n\t\t<p><label>Appointment date <small>(required)<\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"afspraak-date\" \/><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"one-third last\">\n\t\t<p><label>Specialist for intake <small>(required)<\/small> <span class=\"wpcf7-form-control-wrap\" data-name=\"your-browser\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"your-browser\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"Mr. Aous Marchan (dentist)\">Mr. Aous Marchan (dentist)<\/option><option value=\"Mr. Stefano Maraviglia (dentist)\">Mr. Stefano Maraviglia (dentist)<\/option><option value=\"Ms. Nikica Vale (dentist)\">Ms. Nikica Vale (dentist)<\/option><option value=\"Ms. Chayenne Chhangur (dentist)\">Ms. Chayenne Chhangur (dentist)<\/option><option value=\"Ms. Solmaz Shadkam (dental hygienist)\">Ms. Solmaz Shadkam (dental hygienist)<\/option><option value=\"Ms. Sameh Laghaee (dental hygienist)\">Ms. Sameh Laghaee (dental hygienist)<\/option><option value=\"Ms. Sule Utar (dental hygienist)\">Ms. Sule Utar (dental hygienist)<\/option><option value=\"Mr. Rick Wennekes (dental technician)\">Mr. Rick Wennekes (dental technician)<\/option><option value=\"Ms. Roya Ramhormozi (dental care professional)\">Ms. Roya Ramhormozi (dental care professional)<\/option><option value=\"Ms. Heidi Ainetdin (dentist)\">Ms. Heidi Ainetdin (dentist)<\/option><\/select><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"fullwidth\">\n\t\t<p><label>Question \/ comment <span class=\"wpcf7-form-control-wrap\" data-name=\"afspraak-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"An optional question, comment, or message\" name=\"afspraak-message\"><\/textarea><\/span><\/label>\n\t\t<\/p>\n\t<\/div>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-check\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-check\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I agree to the <a href=\"\/algemene-voorwaarden\/\">terms and conditions<\/a> and <a href=\"\/privacy-policy\/\">privacy policy<\/a>.<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n<\/div>\n<div class=\"cf7-submit-button cf\">\n\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n\t<\/p>\n<\/div><input type='hidden' class='wpcf7-pum' value='{\"closepopup\":false,\"closedelay\":0,\"openpopup\":false,\"openpopup_id\":0}' \/><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/section>\n<\/div>","protected":false},"excerpt":{"rendered":"RegisterHomePages Register as a new patient? Would you like to register as a patient at the Your Dental oral care practice? You can do so by completing the contact form on this page. Once we have received your form, we will contact you as soon as possible to schedule an initial appointment. Click here for...","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-27857","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/yourdental.nl\/en\/wp-json\/wp\/v2\/pages\/27857","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/yourdental.nl\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/yourdental.nl\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/yourdental.nl\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/yourdental.nl\/en\/wp-json\/wp\/v2\/comments?post=27857"}],"version-history":[{"count":6,"href":"https:\/\/yourdental.nl\/en\/wp-json\/wp\/v2\/pages\/27857\/revisions"}],"predecessor-version":[{"id":27873,"href":"https:\/\/yourdental.nl\/en\/wp-json\/wp\/v2\/pages\/27857\/revisions\/27873"}],"wp:attachment":[{"href":"https:\/\/yourdental.nl\/en\/wp-json\/wp\/v2\/media?parent=27857"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}