DMO Clinic Enquiry

Appointment details

Are you booking an initial assessment or a follow-up appointment?(Required)

Initial Assessment

Follow-up Appointment

Are you booking an appointment for yourself or on behalf of someone else?(Required)

For myself

For someone else

Are you a parent / carer or a health professional?(Required)

Parent / Carer

Health Professional

Who's the best person for us to contact about arranging an appointment?(Required)

Myself

A parent / carer

The patient

Clinic selection

Do you have a preferred location?

Yes

No, I am flexible with the location but would like an appointment as soon as possible

Which clinic would you like to be assessed in?(Required)

Patient Details

Name(Required)

Date of birth (dd/mm/yyyy)(Required)

Address(Required)

Contact telephone number(Required)

Email(Required)

Parent / Carer Details

Name(Required)

Address (if different from patient)

Contact telephone number(Required)

Email(Required)

Relationship to patient(Required)

Your contact information

Name(Required)

Profession(Required)

Contact telephone number(Required)

Email(Required)

Patient Medical details

Diagnosis and Medical History (including medications, planned or previous surgeries)(Required)

General Mobility Description(Required)

Method of Transferring to a Treatment Couch(Required)

Transfers independently

Transfers with assistance

Transfers with a hoist

Need for Carer or Family Member Presence at Clinic Appointment (Yes/No)(Required)

Yes

Additional Information

Functional goals(Required)

How did you hear about DM Orthotics?(Required)

Which Event?(Required)

Reason for follow up appointment

Your Name(Required)

Your Email Address(Required)

Your Telephone Number

Location

Are you a?

How did you hear about DM Orthotics?

Your Name(Required)

Your Email Address(Required)

Your Telephone Number

Your Country(Required)

Why would you like access to this research paper?(Required)

Research Compilation Document

Hierarchy of Evidence

Ashleigh’s Story

Chloe’s story

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Appointment details

Clinic selection

Patient Details

Parent / Carer Details

Your contact information

Patient Medical details

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Ashleigh’s Story

Chloe’s story

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