Privacy on the healthcare invoice form

This form allows you to use the "privacy on the healthcare invoice" scheme. If you use this scheme, no detailed information on your healthcare program will feature on the invoice, which also goes to your health insurer. After submitting this form, we will draw up a declaration for you. You can come sign this declaration on your next visit to the UMC Utrecht. Further information will be provided in the confirmation email you receive.

UMC Utrecht handles your data carefully and only uses it for the purpose for which you provide it.