Looking for forms for 2024? You'll find them here.

Update your information

• Change your address (My HollandZorg)
• Change your personal information (name, e-mail, telephone number) (My HollandZorg)
• Change your payment details (bank account, means of payment) (My HollandZorg)

Claim forms

• Expense claim - English
• Expense claim - Dutch
• Expense claim - Polish

• Claim form transport costs - English
• Claim form costs home dialysis - Dutch
• Claim form home respiration - Dutch

Application forms

• Patient transport - Dutch
• Non-contracted home care - Dutch

Third party authorization

Would you like to authorize someone to have access to your basic health insurance details? Then please complete and sign the form below.

• Third party authorization form - English
• Third party authorization form - Romanian

Other forms

• Request form payment arrangement
• Request form payment arrangement excess
• Claim form after loss or damage caused by an accident - Dutch