Standard withdrawal form

Only fill in and return this form if you wish to withdraw from your agreement with NurseCare. You can also withdraw via the Withdraw from your agreement page on nursecare.dk or by writing to support@nursecare.dk.

To NurseCare ApS (CVR 10079152), Valdemars Allé 82, 2860 Søborg, Denmark, support@nursecare.dk, tel. +45 70 20 22 32:

I/We hereby give notice that I/we withdraw from my/our contract for the provision of the following service:

  • Service (for example vaccination): __________
  • Ordered on / received on: __________
  • Booking reference (optional - speeds up handling): __________
  • Name of consumer(s): __________
  • Address of consumer(s): __________
  • Email of consumer(s) (so we can confirm receipt): __________
  • Signature of consumer(s) (only if this form is sent on paper): __________
  • Date: __________
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