Confirmation of moveUP subscription HiddenFOR 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.Your country?*Belgium - French speaking partBelgium - Dutch speaking partNetherlandsFranceUnited KingdomUnited StatesOtherIn which hospital will you be having your surgery? (BE-NL)*UZ BrusselAZ AlmaAZ DamiaanAZ DiestAZ RivierenlandAZ Sint-Jan BruggeAZ St-Lucas BruggeAZ Sint-BlasiusAZ HerentalsAZ Maria Middelares (Ghent)AZ MonicaJan YpermanRZ TienenSint-TrudoUZ GentOTHER 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) Yes No Which study? Study on rehabilitation with or without the possible use of a mobile application GEKO Evolution Navio REACTOME: Tele-revalidatiebij patiënten met een autoloog stamcel transplant I don't know AZ AlmaDid you receive an email for approval to participate in the study?* Yes No Which group were you assigned to?* Possibility of using the mobile application WITHOUT a predetermined number of physiotherapy sessions Possibility of using the mobile application WITH a predetermined number of physiotherapy sessions 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 MiddelaresWill you go to the knee and hip class info session of the AZ Maria Middelares hospital?* Yes No I already followed the hip and knee class Name* 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 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 Which brand of activity tracker do you have?* Withings Garmin The 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 activity tracker amount back to you. On which bank account number can we refund the amount? 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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 it Unless 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. I read this and I acknowledge in case I go to another fysiotherapist 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 How would you like to ask your questions? I would like moveUP to call me to discuss I would prefer to submit them in the box below Your questions*How do you feel about starting with moveUP? I'm excited! I'm neutral I'm hesitant Comments (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.