Create a new account

Leids Universitair Medisch Centrum

HIPPO

HIPPO_LUMC

Create a new account

Department	HIPPO Studie
Hospital	Leids Universitair Medisch Centrum
First name of the child
Your account	What is your relation to the child? Mother Father Guardian (male) Guardian (female) Grandmother Grandfather What is your birthdate? dd-mm-yyyy Your e-mail address: Is there someone else taking care of the child? Yes No What is his/her relation to the child? Mother Father Guardian (male) Guardian (female) Grandmother Grandfather What is his/her birthdate? dd-mm-yyyy If you want to create a separate account (with a separate password) for this person please fill in his/her e-mail address. When this field is left blank you will share a single account.
Date of birth of the child	dd-mm-yyyy
Genderof the child	Boy Girl Other
Terms	I agree with the terms and conditions of KLIK
What was the calculated birth date?	dd-mm-yyyy
Ik ben ouder geworden van:	Ik ben ouder van één kind Ik ben ouder van een meerling Indien u ouder bent van een meerling, kunt u in de aangeboden vragenlijsten 'kind' lezen als 'kinderen'.