Patient stops with moveUP Your name (the one filling out this form)* First Last Your email* Patient number of the patient stopping with moveUP*Date the patient stopped* Date Format: DD slash MM slash YYYY Country of the patient*BelgiumNetherlandsFranceUKGermanyIs this a patient participating in the Belgian tele-rehabilitation convention study?*YesNoWhen a patient stops with moveUP the convention obliges the physiotherapist has to send a "notification document" to the mutuality of the patient within 2 weeks after service stop date*I read this and understood:Click here for more information on the notification documentIs this an opt-out or a natural stop due to finish rehabilitation*Natural stop due to finish of rehabilitationPatient opts outNon-responsive (does not react to phone/email/message for more than one week)Patient opt outWhen did the patient opt out?*Before he started using the appAfter he started using the appWhy did the patient opt out?*Afraid of technologyBad experience using appPhysical sessions to far from homePatient wants to work with his or her own physiotherapist (and that physiotherapist does not want to work with moveUP)Patient really want to see a physiotherapist in personOtherWhich other reason?*More explanation/context of the reason for opt out. The more info we get the better.