Bestätigung des moveUP-Abonnements – Support orthopedics

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FOR ADMINISTRATION (hidden from patient): Activity tracker returned?

Yes
No

Take care: this will create an email to the patient when you click save. Make sure the IBAN number is filled out correctly.

What will you use moveUP for?*

Ihr Land? *

In welchem Krankenhaus werden Sie operiert? (BE-NL)*

In which hospital will you be treated? (BE-FR)*

What is the name of your hospital?*

Do you take part in a study (did you sign an informed consent for a study)

Yes
No

Which study?

GEKO
Evolution
Navio
REACTOME: Tele-rehabilitation of patients with an autologous stemcell transplantation
I don't know

AZ Alma

Did you watch the video explaining the moveUP application?*

Yes
No

Was the explanation of the moveUP application clear to you?*

Yes
No

AZ Maria Middelares

Gehen Sie zum Info-Seminar für Knie- und Hüftoperationen vom AZ Maria Middelares-Krankenhaus?*

Ja
Nein
Ich folge bereits dem Hüft- und Kniekurs

Name*

First name Surname

E-Mail-Adresse*

Ihr Handy*

Wenn Sie bereits einen Schrittzähler der Marke „Garmin“ oder „Withings“ haben, müssen Sie keinen neuen Tracker bestellen. Sie können diesen Tracker mit der App verbinden.*

I don't have an activity tracker yet and would like to order
I have my own Garmin/Withings activity tracker so I don't need to order one
I have already received an activity tracker from moveup/the clinic so I don't need to order
I have another brand of activity tracker and decided to report my steps manually in the app, without synchronisation possibility

The use of an activity tracker is highly recommended to keep track of your daily activity. We can provide you with a Garmin Vivofit 4. We ask you to return them when you stop using moveUP*

I don't have an activity tracker yet and would like to order
I have my own Garmin/Withings activity tracker so I don't need to order one
I have another brand of activity tracker and decided to report my steps manually in the app, without synchronisation possibility
I have already received an activity tracker from moveup/the clinic so I don't need to order
I really don’t want to use an activity tracker

Which brand of activity tracker do you have?*

Withings
Garmin

The activity tracker will be charged as a warranty (€69). If you wish you can sent it back to us at the end of your treatment by normal post and we will transfer the activity tracker amount back to you. On which bank account number can we refund the amount?

Adresse*

First line Second line Ort PLZ Land

Preise für moveUP

Der Preis für die Verwendung von moveUP und des Aktivitäts-Trackers hängt von Ihrem Land und Ihrer Klinik ab. Die entsprechenden Preise finden Sie auf folgender Webseite: Preise für moveUP

Können Sie bestätigen, dass Sie den Preis nachgeschlagen haben und mit ihm einverstanden sind?*

I have reviewed the price for the use of the moveUP app and the activity tracker and I agree with it

You will be guided and coached through the application by a team of physiotherapist and/or doctors. For this follow-up, telenomenclature will be charged to your health insurance fund for 40 euro per week. This will be charged directly to your health insurance fund and you will not have to pay for it.

I read this and I agree

It is not possible to combine moveUP and physical session in the presence of a physical therapist in the same week. In the case you also go to a physical session, moveUP will not be reimbursed for that week.

I read this and I acknowledge in case I go to another physical therapist during the use of moveUP, moveUP will not be reimbursed for that week

Kiest u voor moveUP als revaliatietraject voor uw knie of heup, dan gaat u niet naar een reguliere fysiotherapeut vanwege dezelfde aandoening/revalidatie. Ook niet als moveUP is afgesloten.

I read this and I acknowledge in case I go to another physical therapist during the use of moveUP, moveUP will not be reimbursed for that week

Do you still have any further questions about the use of the moveUP application?*

Yes
No

Möchten Sie von einem Mitarbeiter von moveUP angerufen werden?

I would like moveUP to call me to discuss
I would prefer to submit them in the box below

Your questions*

Wie denken Sie darüber, dass Sie moveUP nutzen werden?

Ich bin gespannt!
I'm neutral
Ich fühle mich unsicher

Bemerkung (optional)

By pressing the Submit button, we will process the above data for your moveUP subscription.