Forms for your HollandZorg health insurance
Here you will find the forms you need to change your details, submit a claim or apply for certain forms of care. Most forms are available in multiple languages. That's one of the advantages of HollandZorg.
Looking for forms for 2023? You'll find them here.
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
- Claim form home respiration - Dutch
Application forms
- Seated patient transport - Dutch
- Non-contracted homecare - Dutch
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