Online & GDPR-compliant

Patient forms, everything you need before your appointment

Fill in the health questionnaire and GDPR consent online before your first visit to Tandarts West Rotterdam. Your answers are stored securely and go straight to your patient file. Prefer paper? Each form can also be printed or saved as PDF.

GDPR-compliant storage KNMT-standardised Print or save as PDF

Choose a form

Which form would you like to fill in?

Three forms, each takes about 5 minutes. You'll receive an automatic confirmation by email.

Health questionnaire (adult)

Full medical anamnesis according to the KNMT guideline: medication, allergies, heart and vascular conditions, other diseases and oral health. For adult patients aged 16 and over.

5 min Adults

Start form

Health questionnaire (child)

Short anamnesis for children up to 15 years old, filled in by a parent or guardian. Medical history, oral habits and dental experience of your child.

4 min Up to 15

Start form

GDPR consent form

Official GDPR consent according to the KNMT guideline with 6 consent questions: personal data, medical information, contact with GP, colleague care providers, and email communication.

3 min Privacy

Start form

Secure and GDPR-compliant Your data is sent over a secure connection to your file. To request access or deletion: info@tandarts-west.nl.

Processed immediately You'll receive an automatic confirmation email. We'll discuss any specifics with you in person at your first appointment.

Prefer paper? Each form has a button to print or save as PDF. Bring the completed form with you to your appointment.

Questions about the forms?

Need help filling in or a question about your data? Feel free to call us or send an email.

010 846 6539 Contact page