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.

Nederlands

gender

Male Female Non binair Zeg ik liever niet

Please make a selection

Full Name

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Full Name

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Address

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Postal code

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Hometown

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Telephone number

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Please enter a valid integer number.

Emailadress

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Choose your consulting hour

Monday morning - Fontys Allied Health Eindhoven

Monday morning - Fontys Allied Health - Ultrasound

Tuesday morning - Fontys Allied Health - Ultrasound

Tuesday afternoon-Fontys Paramedisch Eindhoven-Biodex

Tuesday afternoon -Fontys Allied Health - Shoulder

Wednesday morning - Fontys Academy of Arts Tilburg Zwijsenplein

Thursday morning - Fontys Fontys Allied Health Eindhoven - Movement analysis

Thursday morning - Fontys Allied Health Eindhoven

Thursday morning - Fontys Sports performance - Eindhoven

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

Friday afternoon - Fontys Allied Health Eindhoven - Biodex

Friday afternoon - Fontys Allied Health Eindhoven - Health check

No preference/Not sure

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On the website are the consultation times (go to 'overview FCHM consultation hours), 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.

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> Overview FCHM consultation hours

Hereby the link for the consent form:

Toestemmingsformulier-FCHM-30-03.htm

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