Confirmation of moveUP subscription FOR ADMINISTRATION (hidden from patient): Activity tracker returned?YesNoTake care: this will create an email to the patient when you click save. Make sure the IBAN number is filled out correctly.Your country?*Belgium - French speaking partBelgium - Dutch speaking partNetherlandsUnited KingdomOtherIn which hospital will you be having your surgery? (BE-NL)*AZ AlmaAZ Maria Middelares (Ghent)AZ MonicaAZ DamiaanAZ Sint-Jan BruggeAZ Sint-BlasiusAZ HerentalsJan YpermanSint-TrudoUZ GentOTHER HOSPITAL (NOT IN LIST)In which hospital will you be having your surgery? (BE-FR)*Chirec Braine l'AlleudChirec DeltaCHU LiègeGHdCUCL Saint-LucOTHER HOSPITAL (NOT IN LIST)In which hospital will you be having your surgery? (NL-NL)*Park MC (Rotterdam)Amphia (Breda)OTHER HOSPITAL (NOT IN LIST)In which hospital will you be having your surgery? (EN-UK)*Cherwell HospitalOTHER HOSPITAL (NOT IN LIST)What is the name of your hospital?*Do you take part in a study (did you sign an informed consent for a study)YesNoWhich study?Study on rehabilitation with or without the possible use of a mobile applicationGEKOEvolutionNavioI don't knowAZ AlmaDid you receive an email for approval to participate in the study?*YesNoWhich group were you assigned to?*Possibility of using the mobile application WITHOUT a predetermined number of physiotherapy sessionsPossibility of using the mobile application WITH a predetermined number of physiotherapy sessionsDid you watch the video explaining the moveUP application?*YesNoWas the explanation of the moveUP application clear to you?*YesNoAZ Maria MiddelaresWill you go to the knee and hip class info session of the AZ Maria Middelares hospital?*YesNoI already followed the hip and knee classUnited KingdomDo you have access to Paypal for payments?*YesNoName* First name Surname Email* Mobile phone number*The use of an activity tracker is mandatory to use the moveUP app. You can order it below. We recommend the Garmin Vivofit 4. If you already have an activity tracker of the brand "Garmin" or "Withings", you do not need to purchase a new one. You can pair your current activity tracker with the app.*I don't have an activity tracker yet and would like to orderI have my own Garmin/Withings activity tracker so I don't need to order oneI have already received an activity tracker from moveup/the clinic so I don't need to order Which brand of activity tracker do you have?*WithingsGarminThe activity tracker will be charged as a warranty. If you wish you can sent it back to us at the end of your treatment by normal post and we will transfer the amount (69,99 euro) back to you. On which IBAN number can we refund the amount?Address* First line Second line City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Pricing moveUPThe price for the use of moveUP and the activity tracker depends on your country and hospital. You can find your pricing on the following webpage: price moveUPPlease confirm you viewed the price page of moveUP and agree with it*I have reviewed the price for the use of the moveUP app and the activity tracker and I agree with itUnless otherwise stated (one group in telerehabilitation study) it is not possible to combine moveUP and physical session in the presence of a physiotherapist in the same week. In the case you also go to a physical session, moveUP will not be reimbursed for that week and will cost you 40 euro a week.I read this and I acknowledge in case I go to another fysiotherapist during the use of moveUP, this will cost me 40 euro that week.What is the name of your private health insurer (including department)?*Do you still have any further questions about the use of the moveUP application?*YesNoHow would you like to ask your questions?I would like moveUP to call me to discussI would prefer to submit them in the box belowYour questions*How do you feel about starting with moveUP?I'm excited!I'm neutralI'm hesitantComments (optional)By pressing the Submit button, we will process the above data you filled out to be able to order the activity tracker and preparing the moveUP subscription. The moveUP subscription is final when you have registered in the app.