Forms for your HollandZorg health insurance

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

Care requests

• Request form maternity care - Dutch
• Application form seated patient transport - Dutch
• Request form maternity care (after delivery) - Dutch

Third party authorization

Would you like to authorize someone to request information about your public healthcare insurance from us? You can do so by completing and signing the form below.

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

Other forms

• Request form payment arrangement
• Request form payment arrangement excess