Registration Children | Zentrale Praxis ERGOTHERAPIE

Due to high demand, we will not be able to accept any new patients for the specialist area
of neurofeedback until August 31, 2024.
From now on, children can be admitted again with appointments
between 8:00 a.m. and 2:00 p.m.

Registration – Children and Teenager (0-17 years)

Name of the child/ teenager *

Date of birth *

Age

Class *

Name of parents *

Phone number/ mobile number *

Email *

Health insurance company *

Insured *

Attending doctor *

Diagnosis / Abnormalities *

Description of the symptoms

Prescription date (if there is a prescription)

Appointment request:

In order to increase your chance of a timely therapy, we ask you to indicate as many time frames as possible. Please write the times in the corresponding days of the week.

Monday