Thank you for your interest in the mental health services of 'Praktijk Lastage'. In order to be able to help you efficiently, you are kindly requested to fill in the pre-intake form and submit it. It is a comprehensive questionnaire which may take between half an hour and an hour to complete. Filling out this form completely leaves more time during the intake to discuss your specific symptoms and health issues and reduced the time spent on the administrative process. In case you are only interested to find out if there is a waiting time or if Praktijk Lastage can offer care that meets your needs, please use the contact form.
We take your privacy very seriously. Please read the privacy section and choose your privacy settings.
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Als u bezwaar heeft tegen de wettelijk vastgelegde informatieverstrekking van Praktijk Lastage aan uw zorgverzekeraar of het DIS, dan kunt u samen met Praktijk Lastage een privacyverklaring opstellen (zie ook de informatie van de Autoriteit Persoonsgegevens: bron 1, bron2 en de Stichting KDVP). Voor beide soorten gegevensverstrekking bestaan voor en tegenargumenten. Zo is het voorstelbaar dat een ziektekostenverzekeraar graag wil weten welke behandeling vergoedt wordt en draagt anonieme gegevensverwerking door het DIS mogelijk bij aan een hoger niveau geestelijke gezondheidszorg in Nederland. Het is echter aan u om te beslissen of u aan de gegevensverstrekking meewerkt, of dat u een beroep doet op de in de wet verankderde privacyregeling.
You indicated that you don't want your healthcare insurance company to know your diagnosis and/or want to contribute your anonymised treatment details to DIS. For this reason, you will need to sign a privacy statement during the intake. Should you want to claim the treatment cost from your health insurance, you will need to send the signed privacy statement in advance. Note that anonymised NZa rates will be charged for your treatment, otherwise your diagnosis may be deduced from the rate that was charged. Please also understand that the privacy statement may slow down the speed with which your claim is processed by your healthcare insurance. With respect to DIS, Praktijk Lastage will not provide your details.
With the questions below, we would like to find out more about your family history of mental health and substance abuse. The questions are intended to only touch the surface and the family history be discussed in greater detail during the intake if relevant.
Medication
In view of possible drug interactions, it is important that you report all psychofarmaca and somatic medicines that you currently use. This includes for example the anticonception pill or non-regulated drugs such as supplements which are available from drug stores and pharmacies without a prescription.
Intoxication
Excessive use of alcohol or cafeine as well as the usage of drugs can negatively affect your mental health. Moreover, there may be interactions with prescription medication. Therefore it is omportant that you specify your substance usage.
Thank you for registering with Praktijk Lastage. You will be contacted shortly to further discuss treatment options.
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