Registration Form Adults – 18 years and older

Registration Form Adults – 18 years and older

Personal Details
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Due to unforseen circumstances, currently we are unable to provide specialized mental health for international clients. We do provide basic mental health care (in Dutch: generalistische basis GGZ), which can be described as short term treatment for clients with mild to moderate mental health issues.

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• Complete online treatment is only possible for short-term requests for first line help (GBGGZ).

• If our screening reveals that you are eligible for (fully) online treatment, we will inform you about this.

• Advantage: The waiting time may be reduced than with regular treatment on site.

• Please note: with this method there are no options for a physical meeting. All appointments are therefore completely online.

• If it appears during the process that short-term online treatment is not sufficient or appropriate, you will then be placed on the regular waiting list, as of the original registration date.

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(N.B. An incorrectly filled in email address will delay registration & confirmation; double check that the address is correct and legible)

Children (as applicable)
Eldest Child
Second Child
Third Child
Presenting Problem(s) & Symptom(s)
General Symptoms & Additional Information
Alcohol and Medication Usage
Your Help Request
Previous Interventions
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May we wish to request a report, written permission will be required from you personally

Medication
Waiting Time Options
Consent
Via the following questions, we ask you to confirm that you are aware of and give consent for our conditions of service, by circling Yes, each time. By clicking on the question mark at the end of every question, you can reach the appropriate link and information (in Dutch)
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You can read this via Algemene voorwaarden geestelijke gezondheidszorg 2017

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You can find an indication for the current waiting times via www.apanta-ggz.nl/wachttijden.

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Extensive information can be found on our website: www.apanta-ggz.nl/over-apanta/wie-zijn-wij

You can find our Quality Charter via www.apanta-ggz.nl/kwaliteitsstatuut

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Complaints procedure

We ask you to immediately report anything that could lead to a misunderstanding to your practitioner. We gladly discuss these important issues. If the matter cannot be resolved with dialogue and your dissatisfaction remains, you may submit a complaint to our complaints officer using the complaint form on our website. You may also authorise someone else to do this for you. Detailed information and contact details can be found at www.apanta-ggz.nl/contact

This also explains where you take your complaint further if an internal solution cannot be found.

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Privacy Policy

Maintaining privacy is of the utmost importance to us. Before we request information from external sources, consent is sought. We never share your details with others, especially not research agencies without express permission.

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Extensive information can be found on our website: https://www.apanta-ggz.nl/over-apanta/kwaliteit-van-zorg

We will send your invite to the WELLBEE (EPD) online domain, via the e-mail address you provided. Here you can see your documents and appointments.

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Client Council

In order to continue to provide good quality care, we listen carefully to our client’s feedback. In fact, the Client Council is made up of client representatives from each of our target groups. They represent the common interests of our clients. These representatives are aware of our policies and provide ongoing advice on relevant matters. The Client Council represents your interests. They examine our treatment methods and keep an eye on how we manage the waiting list. If you are encountering repeated problems within our system, or have suggestions, you may always take them up with the Client Council. They do not, of course, handle complaints. They can help you to construct an argument or a case for an improvement in service standards.

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Health Insurance, Costs and Apanta

Apanta has contracts with all the major health insurance providers. This means that all treatments under basic and specialist Mental Health provision will be reimbursed. You will not need to pay privately. The system here does however mean that you will need to pay an excess premium of €385 per year if you receive treatment. This is a legal requirement and is valid from the first intake appointment. N.B. the Excess amount may be higher according to your individual policy!

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Cancelling Appointments:

If you need to cancel an individual or group attendance appointment and wish to avoid incurring costs, you will need to do this at least 24 hours in advance of the original appointment time! Where possible, the telephone operator will plan an alternative appointment in for you. You may eventually see this short consultation appear on your health insurance billing information. Outside working hours, you may call and leave a message on the voicemail with your: name, date of birth, practitioners name and appointment date and time. This is so we can use that slot for someone else.

  • If you fail to cancel on time, we are legally obliged to send you a cancelation fee!
  • €35 for a half hour appointment missed
  • €65 for an hour appointment missed, or a group
  • The invoice will be mailed out to you 
  • These invoices are NOT reimbursed via health insurance providers!

There are exceptions as to when we charge costs for cancelling within 24 hours of an expected appointment:

  • You have been involved in a Road Traffic Accident
  • You have been acutely admitted to hospital (or your next of kin has)
  • Someone within your immediate family has died

In this instance, if you tell us on time, no costs will be incurred.
You can find more information about our fees and policies here: www.apanta-ggz.nl/kosten

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Use of Personal Information

Apanta values the high-quality care we provide. The question is, how do we evaluate client satisfaction? To this end, we ask all clients to fill in a questionnaire within our online environment before and after treatment. If you grant permission, this anonymised questionnaire is then sent to the independent “Kenniscentrum” (Knowledge Institute), for healthcare. The anonymous data is also sometimes used for scientific research. Apanta then receives information about treatment efficacy and client needs in return. This all, in order to continue improving care for future clients.