how_to_regRegistration

Maternity Care Registration

Please complete all steps to submit your registration.

person

Step 1: Personal details

First Name*

Initials*

Last Name (as in passport)*

Date of Birth*

Place & Country of Birth*

BSN (if applicable)

Identification type in Spain

NIE/DNI/Passport Number

Nationality*

Language*

Phone Number*

Email Address*

Partner details (optional)

Partner's First + Last Name

Partner: Date of Birth

Partner: Phone Number

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Step 2: Pregnancy details

Due Date*

Current Gestational Age (in weeks)*

Is this your first pregnancy?*

Number of previous births*

Are there any medical indications/complications?*

Do you already have a healthcare provider in Spain?

Which provider (hospital/clinic)?*

Preferred Birth Location

Preferred Hospital Name (if applicable)

Do you want me to assist at the birth / partus assistance (if permitted)?*

health_and_safety

Step 3: Insurance details

Do you have Dutch health insurance?*

Do you have a Restitution policy?*

Health Insurer Name*

Policy Number*

Do you have supplementary insurance for maternity care?*

Do you have an International or Spanish private insurance?*

If yes, name + policy number (optional)

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Step 4: Spanish address

Country or Region*

Street and House Number*

City / Town*

Postal Code*

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Step 6: Documents & Agreements

Please read and agree to the following mandatory documents. You must open and scroll to the bottom of each document to agree.

description

Care Agreement