Registration form

Register in 3 steps

How wonderful that you would like to register with us! We look forward to getting to know you and guiding you through this special journey. Personal care and a strong bond are very important to us.

Fill out the form below.
We will contact you within a few business days.
Together, we will discuss your preferences and schedule your first appointment right away.

Prefer to register by phone? Call us during opening hours: 079 321 71 72.

Register with Kéita

Fill in this form and we will contact you as soon as possible to schedule your first appointment.

Name

Date of birth

BSN (citizen service number) (optional)

On your health insurance card, passport or ID card

Postcode

House number

Including any addition, e.g. 12a

Street

Town

Phone number

Email address

We will send you a confirmation at this address

First day of your last period

Not sure? Then enter an estimate.

Is this date certain or an estimate?

Certain Estimate

Comment about your period (optional)

For example an irregular cycle, recently stopped taking the pill, or already had a scan

Other information (optional)

Anything else you would like to tell us? You can write it here.

I am interested in Centering Pregnancy: pregnancy check-ups together with other pregnant women, in a regular group.

I have read Kéita’s privacy policy (in Dutch) and agree to the processing of my details

More about Contact

Call 079-321 71 72