Application


Application form basic course Therapist
Please fill in all the rubrics marked with a star *
City of the workplace:
Personal data
*Name surname : Pole wymagane.
*Occupation/specialization : Pole wymagane.
*Date of birth : Pole wymagane.
Home address: :
*Street : Pole wymagane.
*City/Zip : Pole wymagane.
*Phone: : Pole wymagane.
*Email: : Pole wymagane.
Place of employment :
*Name of the workplace : Pole wymagane.
*Street : Pole wymagane.
*City/Zip : Pole wymagane.
*Phone: : Pole wymagane.
*Email: : Pole wymagane
*Work experience. Short description : Pole wymagane.
*Member of the medical team treating CP children : Tak     NIE Pole wymagane.
Medical team consists of: MDs physiatrist, neurologist, orthopedic surgeon, Therapists: PT physiotherapist, OT occupational therapist and CPO orthopedic technician.
*Years of working with CP children Pole wymagane.
*Amount of hours per week: Pole wymagane.
Are you familiar with:
*COPM: Tak    NIE Pole wymagane.
*GAS: Tak    NIE Pole wymagane.
*GMFCS: Tak    NIE Pole wymagane.
*MACS: Tak    NIE Pole wymagane.
*GMFM: Tak    NIE Pole wymagane.
*PEDI: Tak    NIE Pole wymagane.
*gait analysis: Tak    NIE Pole wymagane.
*goal oriented treatment: Tak    NIE Pole wymagane.
Good : Pole wymagane.
Sufficient : Pole wymagane.
Insufficient : Pole wymagane.

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