Forms

Want to change your personal details?

Through MyHollandZorg, you can change your personal details, such as your name, address, telephone number or bank account. Simply log in to our secure MyHollandZorg environment and click on 'Update my details'. 

Want to submit a claim?

• Claims form healthcare costs in English
• Claims form healthcare costs in Polish
• Claims form transport costs
• Claims form dialysis at home (in Dutch)
• Claims form home respiration (in Dutch)

Care requests

• Request form maternity care (in Dutch)
• Request form for patient transport

Authorisation

Would you like to authorize someone to request information about your public healthcare insurance from us? You can do so by completing and signing the form below.

• Form for authorising a third party to request information on your behalf

Other forms

Struggling to pay your bills? At HollandZorg, you can request a payment plan that works for you. 

• Request form payment plan
• Request form payment of excess