{"id":1476,"date":"2023-11-23T09:42:00","date_gmt":"2023-11-23T09:42:00","guid":{"rendered":"https:\/\/amstelveenmondzorg.nl\/subscribe\/"},"modified":"2025-03-05T18:58:42","modified_gmt":"2025-03-05T18:58:42","slug":"register","status":"publish","type":"page","link":"https:\/\/amstelveenmondzorg.nl\/en\/register\/","title":{"rendered":"Subscribe"},"content":{"rendered":"<div  class='flex_column av-92usao-0cb23a7b9739ac04542df215f89af599 av_two_third  avia-builder-el-0  el_before_av_one_third  avia-builder-el-first  first flex_column_div  '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-lpb0664i-e9b95bb1b840ef8dfc2d0f18faae7ffa\">\n#top .av-special-heading.av-lpb0664i-e9b95bb1b840ef8dfc2d0f18faae7ffa{\npadding-bottom:10px;\n}\nbody .av-special-heading.av-lpb0664i-e9b95bb1b840ef8dfc2d0f18faae7ffa .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-lpb0664i-e9b95bb1b840ef8dfc2d0f18faae7ffa .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-lpb0664i-e9b95bb1b840ef8dfc2d0f18faae7ffa av-special-heading-h3  avia-builder-el-1  el_before_av_contact  avia-builder-el-first '><h3 class='av-special-heading-tag '  itemprop=\"headline\"  >Sign up as a patient<\/h3><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n<form action=\"https:\/\/amstelveenmondzorg.nl\/en\/register\/\" method=\"post\" data-fields-with-error=\"Found errors in the following field(s):\" class=\"avia_ajax_form av-form-labels-visible   avia-builder-el-2  el_after_av_heading  avia-builder-el-last   \" data-avia-form-id=\"1\" data-avia-redirect='' ><fieldset><p class='  first_form  form_element form_fullwidth' id='element_avia_1_1'><label for=\"avia_1_1\">First name <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_1_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_1_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_2_1'><label for=\"avia_2_1\">Surname <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_2_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_2_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_3_1'><label for=\"avia_3_1\">Phone number <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_3_1\" class=\"text_input is_empty\" type=\"text\" id=\"avia_3_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_4_1'><label for=\"avia_4_1\">Email <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_4_1\" class=\"text_input is_email\" type=\"text\" id=\"avia_4_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_5_1'><label for=\"avia_5_1\">Date of birth <abbr class=\"required\" title=\"required\">*<\/abbr><\/label> <input name=\"avia_5_1\" class=\"avia_datepicker text_input is_empty\" type=\"text\" id=\"avia_5_1\" value=\"\" placeholder=\"DD \/ MM \/ YY\" inputmode=\"none\" \/><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_6_1'><label for=\"avia_6_1\">Street name + House number<\/label> <input name=\"avia_6_1\" class=\"text_input \" type=\"text\" id=\"avia_6_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_7_1'><label for=\"avia_7_1\">Zip code + City<\/label> <input name=\"avia_7_1\" class=\"text_input \" type=\"text\" id=\"avia_7_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_8_1'><label for=\"avia_8_1\">BSN (expedites enrollment)<\/label> <input name=\"avia_8_1\" class=\"text_input \" type=\"text\" id=\"avia_8_1\" value=\"\" \/><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_9_1'><label for=\"avia_9_1\" class=\"textare_label hidden textare_label_avia_9_1\">Message <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><textarea  name=\"avia_9_1\" class=\"text_area is_empty\" cols=\"40\" rows=\"7\" id=\"avia_9_1\" ><\/textarea><\/p><p class='  first_form  form_element form_fullwidth' id='element_avia_10_1'><input  name=\"avia_10_1\" class=\"input_checkbox is_empty\" type=\"checkbox\" id=\"avia_10_1\" value=\"true\"\/><label class=\"input_checkbox_label\" for=\"avia_10_1\">I agree to the house rules and have read the intake page <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><\/p><p class=\"hidden\"><input type=\"text\" name=\"avia_11_1\" class=\"hidden \" id=\"avia_11_1\" value=\"\" \/><\/p><p class='   form_element form_fullwidth' id='element_avia_12_1'><span class='value_verifier_label'>0 + 6 = ?<\/span><input name=\"avia_12_1_verifier\" type=\"hidden\" id=\"avia_12_1_verifier\" value=\"217161774\"\/><label for=\"avia_12_1\">Please prove that you are human by solving the equation <abbr class=\"required\" title=\"required\">*<\/abbr><\/label><input name=\"avia_12_1\" class=\"text_input captcha\" type=\"text\" id=\"avia_12_1\" value=\"\"\/><\/p><p class=\"form_element \"><input type=\"hidden\" value=\"1\" name=\"avia_generated_form1\" \/><input type=\"submit\" value=\"Shipping\" class=\"button\"  data-sending-label=\"Sending\"\/><\/p><\/fieldset><\/form><div id=\"ajaxresponse_1\" class=\"ajaxresponse ajaxresponse_1 hidden\"><\/div><\/p><\/div><div  class='flex_column av-2lhib4-033198e8041caddd42af44eca71760ef av_one_third  avia-builder-el-3  el_after_av_two_third  avia-builder-el-last  flex_column_div  '     ><p><div  class='avia-button-wrap av-lpb07rsj-c0dc3ae6df5c7aa6aeeaee6ec9b7db4b-wrap avia-button-left  avia-builder-el-4  el_before_av_button  avia-builder-el-first '><a href='https:\/\/amstelveenmondzorg.nl\/en\/treatments\/intake-consultation\/'  class='avia-button av-lpb07rsj-c0dc3ae6df5c7aa6aeeaee6ec9b7db4b av-link-btn avia-icon_select-yes-left-icon avia-size-large avia-position-left avia-color-theme-color'   aria-label=\"More information about the intake\"><span class='avia_button_icon avia_button_icon_left' aria-hidden='true' data-av_icon='\ue881' data-av_iconfont='entypo-fontello'><\/span><span class='avia_iconbox_title' >More information about the intake<\/span><\/a><\/div><br \/>\n<div  class='avia-button-wrap av-m7w9tcee-0a737c0dff557cf7ec9df2553e5e1e94-wrap avia-button-left  avia-builder-el-5  el_after_av_button  avia-builder-el-last '><a href='https:\/\/amstelveenmondzorg.nl\/en\/operating-procedures-home-rules-and-your-dental-bill\/'  class='avia-button av-m7w9tcee-0a737c0dff557cf7ec9df2553e5e1e94 av-link-btn avia-icon_select-yes-left-icon avia-size-large avia-position-left avia-color-theme-color'   aria-label=\"Read the house rules\"><span class='avia_button_icon avia_button_icon_left' aria-hidden='true' data-av_icon='\ue881' data-av_iconfont='entypo-fontello'><\/span><span class='avia_iconbox_title' >Read the house rules<\/span><\/a><\/div><\/p><\/div><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1476","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Subscribe - Amstelveen Mondzorg<\/title>\n<meta name=\"description\" content=\"The Dentist of Amstelveen: \u2713 always a familiar face \u2713 No chain \u2713 Cosmetic dentistry \u2713 Short waiting times \u2713 Oral hygienist\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/amstelveenmondzorg.nl\/en\/register\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta 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