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/ Diet statement Drs. An van Veen (Performance code 24200, AGB code: 84021556, AGB clinic: 90064562)| € 19.00
Diet statement Drs. An van Veen (Performance code 24200, AGB code: 84021556, AGB clinic: 90064562)| € 19.00
€
19,00
Performance code 24200, AGB code: 84021556, AGB clinic: 90064562
Requesting dietary statement
Email address
Name
First name
Surname
Date of birth
DD slash MM slash YYYYY
RECEPTIONS
Periode van
(Required)
MM slash DD slash YYYYY
Periode tot
(Required)
MM slash DD slash YYYYY
Voorgeschreven dieet
(Required)
I have had a consultation at BeterKliniek for the past six months?
Yes
No
I agree to pay €19 for a diet statement
Yes
No
I certify that I am still following the prescribed diet
That is correct
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Based on the information you provided, you cannot request a diet statement. Please contact us during the free patient consultation hour: 040-7117337
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Diet statement Drs. An van Veen (Performance code 24200, AGB code: 84021556, AGB clinic: 90064562)| € 19.00 number
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