Intake Form

Form

Before we can start your treatment, we kindly ask you to complete your personal details and medical information.

We need these details to:

• Register you correctly in our system;
• Start your treatment with a valid care profile;
• Claim the costs from your health insurer.

By completing the form on time:

• You avoid delays in starting your therapy;
• You help us assist you more quickly and effectively;
• Your therapist knows exactly what you need from the very start