Authorise someone else

Would you like to give a relative permission to provide the necessary information about your clinical picture, the care and support you need, your health and your place of residence at all times? This consent form is particularly intended for situations in which you yourself are unable or insufficiently able to properly look after your medical interests yourself.

After the form complete completed, please hand it in to the assistants in the practice or mail it to contact@huisartsenpraktijkwesteinder.nl.