Ki-Anne: praktijk voor supervisie en shiatsu te Amsterdam    
 


In order to create your personal account you are requested to provide a number of data in the form below. On activation of your account you can change your data at any time. Your name, address data and email address are required for booking therapy appointments and sending invoices afterwards.

 

Create account

Prefix: *

First Name: *

Last Name Prefix:

Last Name: *


Email Address: *


   

Allowed formats:

  • 0201234567
  • 020-1234567
  • +31201234567
  • +31-20-1234567

Phone Number:

Mobile Phone Number: *


Country: *

   

Addresses in the Netherlands only:
After entering a Dutch postcode and house number the corresponding street and city will be looked up and shown. If necessary these can be manually changed.

Postcode: *

House Number: *

Street: *

Optional address info:

City: *


Areas of Interest: *

How did you hear about us?: *


   

Requested format:

  • between 8 and 24 characters
  • min 1 digit [0-9]
  • min 1 lowercase letter [a-z]
  • min 1 uppercase letter [A-Z]
  • min 1 special character:
    ~ ! # $ % ^ & * ( ) - _ + =

Enter your password: *

Re-type your password: *


Acceptance of terms of use: *

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