Intake Form

Yes We Can Youth Clinics helps teenagers and young adults (aged 13-25) suffering from mental health issues, and their families. You can register by filling in the intake form below. Upon receipt, we will contact you to schedule a personal intake interview. Please take a look at our current waiting times.

During the interview, we will examine whether our programme is suitable for the problem(s) you and your child currently experience. It is important to bring the following documents along (without them, the intake cannot take place):

  • Valid ID Card/passport of participant
  • Previous medical/psychological/other reports
  • List of medication from pharmacy
  • Medical ID Card or health insurance policy

If you have any additional questions, our Case Management is ready to assist you Monday to Friday from 9:00 a.m. to 10:00 p.m. and on Saturday and Sunday from 10:00 a.m. to 4:00 p.m. (GMT +1) via phone number: +31 (0)85 02 01 222.  Visit our investment page for more information about the costs of our treatment programme.

All your questions, registration documents and personal information will always be dealt with in a confidential manner and with the utmost care.

Although some countries still imposed travel bans/regulations,  it is in most ways still possible to travel, as long as there is a medical necessity. Please call us at +31 (0)85 02 01 222 so together we can check travel regulations with your local government, help you with the required medical documents and find ways to travel to the Netherlands.

 
Information: Contact Person
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Information: Participant
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For our records only, not to be contacted




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Family and Parental authority


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Problems of participant
General information family doctor
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