Physical therapy convention – Support orthopedics

Name*

First Last

Email*

Your RIZIV number*

Name of your practice or organisation*

Address of your practice or organisation*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

To be allowed to attest the pseudocodes in the convention you need to digitally agree with the convention tele agreement convention tele agreement . Weekly we have to send a list to RIZIV with the physiotherapist who agreed with the convention and followed the e-learning course of moveUP.

Digitally 'sign' the teleagreement mentioned above:

I read the tele agreement and I agree and sign off for it

All physical therapists who sign the convention are listed on the moveUP website and on the axxon website. Do you consent to add your contactdata to this list?*

Yes
No

Did you already complete the e-learning course?*

Yes
No

On a scale of 1 to 10: What did you think of the course?*

Can you give us some suggestions for improvement of the e-learning?

You can only include patients if you completed the e-learning course. Click here to follow the e-learning : e-learning course of moveUP.

Optional remark

Physical therapist convention