Infinity Baby's

Registration form

Are you pregnant and looking for reliable maternity care? Fill out the form below and we will contact you as soon as possible to discuss the possibilities.

Registration form

First name

Girls last name

Street name house number

Postcode

Place of residence

Phone number

Email address

Date of birth

Nationality

BSN number

Marital status

How many child

Name and Date of Birth of other children

Are there pets present? If so, which ones?

Due date

Where do you want to give birth?

Name of midwifery practice/Gynecologist

Power supply

Health insurer

Type of insurance

Police number

Proof of identity

Document number

Valid until

Here you can place your specific wishes / questions or comments

To register

Ik ga akkoord met het privacybeleid en bevestig dat mijn persoonlijke gegevens in overeenstemming met de wet mogen worden gebruikt