We warmly welcome you and your child to our practice! You are about to register your child for a first consultation with our pediatric dentist, Rory Ubbink. In preparation for this first consultation, we ask that you complete and sign the following registration form fully and truthfully. We process your privacy-sensitive data in accordance with privacy legislation (AVG).
While completing the registration form, we will ask you to attach a digital copy of the referral letter (.doc, .docx, or .pdf) and any X-rays that may have been taken (.jpg, .jpeg, or .png).
Please make sure you have received these documents from the referring (your own) dentist before filling out the registration form, and that you can easily access them on your phone, tablet, or computer so that completing the form goes smoothly.
The form consists of the following sections: personal and contact details, reason for referral, health and development, the anxiety questionnaires, and oral hygiene, diet, and oral habits.
Once the registration form is complete, we will contact you to schedule an appointment for the first consultation with our pediatric dentist.
The first appointment is an intake consultation. During this appointment, you and your child will meet the pediatric dentist and the teeth of your child will be examined. A treatment plan and preventive program will then be drawn up. We seldom carry out treatment during this visit.
To ensure that the visit to the dentist goes smoothly and calmly, we ask you to come with only one parent/guardian and to bring no brothers or sisters.
We would also ask you to bring proof of identity (ID card/passport) and your insurance card so that we can verify this information in our system.
Please note that a treatment plan and preventive program will be drawn up and discussed during the first appointment. The person accompanying the child should be authorized to give consent for the proposed treatment so we can schedule appointments right away. We will also provide information on treatment options during intake.
It is also the responsibility of the parent/guardian present at the intake to inform any second parent/guardian about the agreed-upon appointments and treatments.
The pediatric dentist speaks Dutch and English. If the parent/guardian accompanying the child does not speak or understand these languages, we ask you to bring someone who can translate for you. An intake consultation conducted solely via a translation app (e.g. Google Translate) is not possible. The translation app may only be used as a support tool if something is not fully or correctly understood.
Dental care for children under the age of 18 is covered by basic health insurance. The costs of the intake, treatments, and preventive aftercare will be fully covered by your health insurer. We need to seek approval from your health insurer for some of the treatments. Rest assured, these costs are entirely covered.
Appointments that are missed or canceled with less than two working days’ notice will, in principle, be charged.
