Application form Application form Name (required): E-mail (required): Date of birth (required): Telephone number: BSN: Address: Zip code: Reason registration: Make a choiceDesire to have childrenPregnancyBirth controlOther subject Date first day of last menstrual period: Additional message: Or either Sent a mail to info@verloskundigenwageningen.nl with your phone-number and we call you back. Or call us during 09:15 and 12:00 at 0317-411971