Dataset Access Request Form

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By using this data request form, you can apply for the dataset from the National Health Data Catalogue. Is this your first time using this form? Here, you can find additional information about the data request process and guidance on how to fill the form.

Information on the data requestor and the request
Description of the project and dataset needed
Approvals, Plan and Statements
Confirmation

In this section, you are asked to provide information about yourself and your project that can be shared with the public. Make sure this does not include any confidential information.

Are you requesting access to the dataset on behalf of an organization or as an individual?

If other, please specify

If "other" has been filled in, please state the type (e.g. legal entity)

If, on behalf of an organization, then which?

If on behalf of an organization, who is the delegated responsible person?

First name of the data requestor

Last name of the data requestor

Mobile/telephone number of the data requestor

Please use the following format: +31 6 12345678

Email address of the data requestor

Please provide email address with domain name (e.g., john.doe@example.nl)

Country of the requesting entity

Title of the requested dataset

Dataset identifier

From which data holder(s) will the data be extracted?