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Contact form

Please fill out the form below to let us know which service you are interested in and how we can help you. We will contact you as soon as possible.

Which service are you interested in?

If it is rehabilitation, tell us your goal and current situation (mobility, gait, balance, arm/hand, fatigue, pain, autonomy…).

Fill out only if rehabilitation therapies are required.

Only if rehabilitation therapies are required.

Time since diagnosis
Less than 3 months
3–6 months
6–12 months
1–2 years
More than 2 years

Only if rehabilitation therapies are required.

Only if rehabilitation therapies are required.

Current state of mobility
She walks without assistance.
Walks with assistance (cane/walker)
Uses a wheelchair
It depends on transfer assistance

Only if rehabilitation therapies are required.

Availability to attend consultation
Mornings
Afternoon
Indifferent

Only if rehabilitation therapies are required.

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BOOK YOUR APPOINTMENT
AT GOGOA CLINICS

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