olinek@olinek.com.pl
+48 22 120 20 50
+48 22 559 21 37
This survey is dedicated to those who have already been patients at Olinka. By completing it, you will help us better tailor the schedule to your preferences. We invite you to sign up for a session at Olinka:
Patient's Full Name
Your Email Address
Phone Number
Child's Weight in Kilograms
Child's Height in Centimeters
Preferred Start Date of Session
Preferred End Date of Session
We operate from 8 AM to 5 PM - What hours can your child attend sessions? Check the hours (multiple choice field) 8-1010-1212-1414-16
Does your child need breaks between therapies? YesNo [group breaks-group] Please provide details about the break. How long should it last, and at what time should it be? [/group]
Which therapies does your child want to participate in during the session? Choose therapies and the number of hours.
Physical Therapy / Functional Therapy [group therapy-hours-1] Choose how many hours per day: 1h1h + 1h1.5h1h + 1.5h1.5h + 1.5h2h2h + 1h2h + 1.5h2h + 2h2.5h2.5h + 1.5h [/group]
NDT Bobath Baby for Premature and Infants [group therapy-hours-2] Choose how many hours per day: 1h1h + 1h1.5h [/group]
Hand Therapy [group therapy-hours-3] Choose how many hours per day: 1h2h3h [/group]
Sensory Integration [group therapy-hours-4] Choose how many hours per day: 1h2-3 times a week [/group]
Strength Training [group therapy-hours-5] Choose how many hours per day: 1h1.5h2h2.5h [/group]
Neurologopedist [group therapy-hours-6] Choose how many hours per day: 30 min1h2-3 times a week [/group]
Vision Therapy [group therapy-hours-7] Choose how many hours per day: 30 min1h2-3 times a week [/group] Psychologist [group therapy-hours-8] Choose how many hours per day: 1h2-3 times a week [/group] G-EO System Prof. A. Tomatis Therapy Stage I Prof. A. Tomatis Therapy Stage II or subsequent Dog Therapy Prodrobot / Innowalk Aquatic Treadmill Hyperbaric Chamber Osteopath Stochastic Resonance - Additional +40 PLN to the basic therapy price
Do you have any preferred therapists? If yes, please mark them on the form (select at least a few therapists) Yes, I have preferred therapistsNo, match therapists to my schedule [group therapist-group] Marcin AdamusAgnieszka BorysiakPaulina JaszczukKatarzyna JuszkowskaAleksandra KrawczykDaniela KowalickaKinga Niewczas – PerkowskaJustyna ParuzelAleksandra RosłoniecElżbieta RybarczykAnna StęplowskaNatalia SzokalskaKarolina Gromak-KalinowskaPaula ZachariaszAgata SumińskaRenata PopiółSonia GachJoanna GrzejszczykMartyna StalaLuiza MichniakAdrian PaciepnikKatarzyna ChmielewskaPaulina DzwoniarskaNatalia WyszywaczTeresa FurmanKatarzyna BurchardPaulina GiezekIwona PiłatNatalia Proskuriakova [/group]
NOTES – important for the next session that the therapist should know
