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Applicationform holiday dialysis

Are you looking for a dialysiscentre because you need temporary dialysis? We offer treatments at our centres in Utrecht (Gezondheidshuis), at the Amsterdam UMC, or in a dialysishub. Please fill in the following applicationform.

Application form Holiday Dialysis

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Name(Vereist)
Email address(Vereist)
DD slash MM slash JJJJ
Gender(Vereist)
Address(Vereist)