Happy Pet Health Plan Health programme for your pet 1General informationName*First name*Address* Street Address City State / Province / Region Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Email* IBAN bank account number2Your pet(s)YBelow you can enter a maximum of 2 pets. If you have more than 2 pets, please contact us.Pet 1Name*Which plan do you want to register for?*ActivePremiumPayment per*MonthYearActive plan*Dog < 10kgDog 10-25kgDog > 25kgCatActive plan*Dog < 10kgDog 10-25kgDog > 25kgCatPremium plan*Dog < 10kgDog 10-25kgDog > 25kgCatPremium plan*Dog < 10kgDog 10-25kgDog > 25kgCatWhich plan do you want to register for?*Kitten planPuppy planMore info about kitten planMore info about puppy planPet 2 Add another pet Name*Which plan do you want to register for?*ActivePremiumMore info about these plans.Active plan*Dog < 10kgDog 10-25kgDog > 25kgCatActive plan*Dog < 10kgDog 10-25kgDog > 25kgCatPremium plan*Dog < 10kgDog 10-25kgDog > 25kgCatPremium plan*Dog < 10kgDog 10-25kgDog > 25kgCat3Total per month3Total per yearTotal 0,00 € Excluding one-time registration fee of 9,50 euro. Subscribe me to the newsletter of Dierenkliniek Spaarne * Ik ga akkoord met het privacybeleid
