International Headache Clinic Headache Questionnaire
Please complete this questionnaire as fully as possible before your appointment. After submitting you will automatically receive a copy by email. Fields marked * are required.
Please note:
- Treatments provided are not or only partially reimbursed when you submit the invoice to your health insurer (see www.internationalehoofdpijnkliniek.nl for rates).
- Appointments not cancelled at least 24 hours in advance will be charged.
Thank you!
Your questionnaire has been submitted. You will receive a copy by email within a few minutes (please also check your spam folder).