Casemanager (CoZo)

Care path Vita Nova
Care path

Pregnancy healthcare plan
Prenatal plan
Birth plan
Postpartum plan




During the intake we want to get to know you and your partner better. That is why we would like to ask you to fill in the questionnaire below in preparation for the intake interview. The questions are about your health and about diseases and/or (congenital) defects that may occur in yourself, your partner and immediate family. On the basis of this information, we can assess whether there are aspects that we need to take into account during the pregnancy, the delivery and/or the maternity period. During the intake we will go through the questionnaire with you. The data is handled and stored with care. We comply with the applicable statutory privacy regulations.

The intake form is in Dutch if necessary you can use google translate or call us if you have any questions!

  • Algemene (NAW)-gegevens
  • Algemene gezondheid en medicatie
  • Anamnese partner en familie

Partner (indien van toepassing)