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Elderly advice

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Ik verklaar de privacyverklaring te hebben gelezen en ik geef toestemming om mijn (persoons) gegevens te verwerken.

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Ik verklaar de leveringsvoorwaarden te hebben gelezen en ga hiermee akkoord om gebruik te maken van de diensten van Sterker Ouderenwerk.

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Home care and groceries arranged

Mr. Vinken, 76 years old

“The senior advisor helped me so much. I now have home care and someone comes every week to do my shopping. That way I can keep going at home for a while.”

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Sign up for Elderly advice

Salutation *
Initials *
Name *
Date of birth *

Ik verklaar de privacyverklaring te hebben gelezen en ik geef toestemming om mijn (persoons) gegevens te verwerken.

Privacy Statement *

Ik verklaar de leveringsvoorwaarden te hebben gelezen en ga hiermee akkoord om gebruik te maken van de diensten van Sterker Ouderenwerk.

Leveringsvoorwaarden *
Street name *
House number *
Postal Code *
Place of residence *
Phone number *

You can fill in the details of a possible contact person later

Email address *
Why would you like to contact a senior advisor? *
Please fill in your answer briefly
Do you want to apply for a Wmo provision? *

Would you like to get in touch?

Would you like to get in touch? *
Who is the best person to contact?
Contact person name *
Contact person phone number *
Contact person email address *
Customer relationship *
Otherwise, namely
Fill in your relationship to the customer

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