Registration form

To register you need a referral from your general practitioner. More information about the reference can be found on the page reference and registration. If you are already in possession of a referral letter you can register via the registration form below. The referral letter can be uploaded.


Family name*

Street and house number*

ZIP code and residence*

Date of birth*

Telephone number

Mobile number

E-mail address*


Health insurance company*

Policy number insurance*

Marital status

Name of the GP practice*

Name of the general practitioner*

Address of the GP

Telephone number of the GP

Fax of the GP


Have you previously had psychological treatment or have you followed an intake procedure at an institution? If so, what was your treatment and who was the practitioner/psychologist?/ Which institution was it?

Name of the institution
Type of treatment
Name/function of professional/address and telephone number

If you answered ‘yes’ to the previous question: What was the reason for these treatments and what was the reason for the termination of these treatments?

Mention the nature of your main symptoms / problems in your own words

Since when do these symptoms/problems exist?

What do you think was the reason and / or cause of the symptoms / problems?

What have you tried to address the symptoms / problems ? What worked well and where did this occur?

What is the reason that you now (or again) seek help?

Who did refer you to a psychotherapist / psychologist and how do you feel about this referral?

What do you expect from the psychologist who tries to help you?

Supervision and learning therapy Within the context of the education for mental health psychologist (GZ-psycholoog), psychotherapist and/or psychiatrist there is de possibility of signing in for supervision and/or learning therapy. Supervision can be given for schema therapy, behavioural therapy, person centred and experiential therapy, EFT-individuals therapy. You can also sign in for the BAPD from the NIP.
The costs for supervision and learning therapy are € 100,00 Euros per 60 minutes (45 minutes contact time and 15 minutes indirect time).

Referring and signing up
To receive reimbursement of costs from your insurance company, you will need a reference letter from your general practitioner.
Insurance companies want the referrals to meet certain requirements.
You can check whether your referral meets the requirements, by studying the information mentioned below.

The following needs to be mentioned in your referral letter:
• Is their a reference to either BG-GZ or S-GGZ?
• What is the diagnosis or which is the disorder suspected by the general practitioner that is registered in DSM V and that meets the requirements for eligibility for reimbursement?
• Is the date of referral mentioned?
• Is their an official stamp and signature of the general practitioner?

You will find some examples of a referral letter of either B-GGZ or S-GGZ down below:
• example referral letter ‘generalistische basis GGZ’
• example referral letter ‘specialistische GGZ’

Signing up:
To sign up, use this application form of this website. You will also need a referral letter from your general practitioner for both signing up and to be able to receive reimbursement from your insurance company. After both the referral and the application form are received, you will be contacted. In this conversation, there will be discussed whether it is necessary to provide more information. In case of a waiting list, you will be informed about the length of the waiting time. Information about the waiting list is under the head ‘waiting period’. You can leave a voicemail when you call. Please leave both your name and phone number in this voicemail and your call will be answered.

Laws and regulations
We work within the frameworks of the legislation and regulations.
For example, the law on the medical treatment agreement applies (WGBO)
The professional code beroepscode for psychotherapists applies.
This professional code stipulates, among other things, that everything that is discussed is treated with the utmost confidentiality.
This means that information is only given to third parties after your written consent.
Your doctor will be informed with your approval, as stated in the statement of approval.
Provision of information and exchange of information with third parties such as company doctor and / or insurance medical doctor, takes place in writing.
The information will be discussed with you in advance and you will receive a copy of the letter.
No information is provided to lawyers in accordance with the guidelines of the Royal Dutch Medical Association KNMG.
Data that are minimally required for reimbursement by the health insurance company are made available to the relevant authority with due observance of the aforementioned safety standards.
The professional code of the NIP is also mentioned, which is applicable:
In the BIG Register you can look up the registrations of healthcare professionals:

Medical file and confidentiality
A file is created and kept for the treatment.
All data that are important for the treatment are recorded in it.
From the age of 16 clients have the right to view their file.
Others may only view the file if you give permission in writing. You can also withdraw this permission later.
Even after your death, others are not entitled to access your file.
If certain information turns out to be incorrect, you have the right to have improvements, additions or changes made.
The file is the property of the practice and therefore cannot be taken. You can, however, get a copy of a part or of the entire file. The costs will be charged.
The file is stored for 15 years after the end of the therapy.
This is the legally required term. Then it is destroyed.
Contracts in 2018
In 2018 I will only have a contract with DSW and its labels
DSW, ASR, Stad Holland, In Twente, Ditzo, Amersfoortse, Aevitae.

When I do not have a contract with an health care insurer, I use the prices as set by the NZa.
These are the current prices for BG-GGZ in 2018:

These are the current prices for S-GGZ in 2018:

Health care not reimbursed by the insurer
Additional (care)product ‘overig zorgproduct (OZP) S-GGZ
Treatment of certain problems will not be reimbursed according to the healthcare insurance agreements and thus are not eligible for reimbursement.
Partner - relationship therapy will not be reimbursed. The exception to this is when an underlying psychological problem is the cause of relationship problems. In which case your general practitioner can write you a referral letter.
Relationship therapy sec, work problems and adjustment disorders will not be reimbursed.
Whenever you would like treatment for these particular problems, you would be obliged to take care of the expenses yourself. Then treatment interviews will be charged per session. In some cases you will be able to partially get your costs reimbursed when you have an additional insurance ‘aanvullende verzekering’ . Always consult your insurance company about this issue.

Prices additional (care)product ‘Overig zorgproduct’ (OZP)
The maximum OZP-price for the ‘ozp non basic package consult’ is determined by the NZa and consists of the following price in 2018: € 101,03 per session of 45 minutes. There is no BTW involved. You do not need a referral from your general practitioner.

The price is:
Therapy € 134,68: including
€ 101,03 per session (45 minutes direct time) and 15 minutes (indirect time)
Partnerrelationship therapy € 168,35
€ 134,68 per session (60 minutes direct time) and 15 minutes (indirect time)

Next to the costs per session, additional indirect time (i.e. creating treatment plan, diagnostics,, communication with general practitioner, etc.) will also be charged. The costs for this is € 101,00 per 60 minutes.

Terms of payment
The terms of payment apply to all parts and arrangements.
You are responsible for the payments.

Upload referral letter
Scan your referral letter and add it using the upload function below.

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