Application form Patientsupport

Call Patient Support at least four working days in advance using the form below. We will then answer within three working days. Good to know: there are no waiting lists.

Informal carer or professional

Aid applicant

Appointment

Format: DD-MM-YYYY
Note: for St. Jansdal, it is important to know whether it is Lelystad or Harderwijk
Resources(optional)

Do you use transport provided by someone else? If so, please fill in the details below.

Have you booked the return trip as well?
Do you give permission to contact the professionals involved to coordinate the help provided?

We handle your data with care. You can find our privacy statement at Privacy Statement | Welzijn Lelystad.