You can complete this form only after the doctor has asked for it. This is because the doctor must first link your treatment and any medications and infusions. 

Informed Consent

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Name
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Address
Under the Medical Treatment Agreement Act (WGBO), all doctors in the Netherlands are required to properly inform their patients. This is called informed consent. Patients must acknowledge receipt of this information, in principle, with their signature. It also involves written consent for examination (making the diagnosis) and treatment (receiving therapy). Especially this concerns (integral) medicine with specialization in naturopathy, orthomolecular medicine, epi-genetic medicine homeopathy, infusion therapy and biophysical research and treatment methods which are not (yet) officially recognized as scientifically proven in the Netherlands. Especially because of their effects and side effects. In addition to regular activities, the BeterKliniek also offers these non-regular methods.
Hierbij bevestig ik, ondergetekende, dat ik voldoende ben voorgelicht en bewust kies voor de reguliere en niet reguliere diagnostiek en therapie in BeterKliniek ook als het om mijn kind(eren) gaat. In detail gaat het hierbij om het volgende:(Required)
The undersigned declares, after reading the above points and based on the information already received, to have come to an informed decision and voluntarily consents to undergo treatment at BeterKliniek.
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