
Forms HollandZorg

Update your information
- Change your address (My HollandZorg)
- Change your personal information (name, e-mail, telephone number) (My HollandZorg)
- Change your payment details (bank account, means of payment) (My HollandZorg)
Claim forms
- Claim form transport costs - English
- Claim form costs home dialysis - Dutch only
- Claim form home respiration - Dutch only
Care requests
- Request form maternity care - Dutch only
- Application form seated patient transport - Dutch only
- Request form maternity care (after delivery) - Dutch only
Third party authorization
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.
- Third party authorization form - English
- Third party authorization form - Romanian