Registration form FCHM: Musculoskeletal complaints

This form contains one or more fields that will be filled automatically after you log on with a Fontys account.

You're previously saved incomplete form cannot be found in the database. Please complete the form again.

Nederlands

male/female

Male Female

Please make a selection

Full Name

This field is required.

Full Name

This field is required.

Street and number

This field is required.

Postal code

This field is required.

Hometown

This field is required.

Telephone number

This field is required.

Please enter a valid integer number.

Emailadress

This field is required.

Please enter a valid email address.

Choose your consulting hour

Monday morning - Fontys Allied Health Eindhoven

Monday morning - Fontys Allied Health Eindhoven - Spine

Monday afternoon - Fontys Allied Health Eindhoven

Tuesday morning -Fontys Allied Health- Shoulder

Tuesday afternoon - Fontys Allied Health - Ultrasound

Wednesday - Fontys Paramedisch Eindhoven - Fitness

Wednesday - Fontys Fontys Allied Health Eindhoven - Movement analysis

Thursday - Fontys Allied Health Eindhoven

Thursday - Academy of Circus and Performance Art - Tilburg

Thursday - Fontys Sports performance - Eindhoven

Friday- Fontys Sports performance - Eindhoven

Friday - Fontys Allied Health Eindhoven - Sport medical and Rehabilitation medical consultation

Friday - Fontys Allied Health Eindhoven - Biodex

Friday - Fontys Allied Health Eindhoven - Health check

No preference/Not sure

Please make a selection

On the website are the consultation times, indicate here your time of preference. Please note that this is not an appointment yet! You will always be contacted first to make an appointment.

This field is required.

Hereby the link for the consent form:

https://fontys.nl/Over-Fontys/Fontys-Paramedische-Hogeschool/Centre-of-Health-Movement/Spreekuren-Fontys-Centre-of-Health-and-Movement-1/Eerstelijns-diagnostiek-Bewegingsklachten.htm

Please print and fill out the form and bring it to the consultation.