Follow-up request for :
WomenManChild
Follow-up request for physiotherapy :
Pelvi-spinal injuries / perinatal orthopedic physiotherapyWeakness of the abdominal strap / abdominal diastasis
Request for follow-up in massage therapy :
Massotherapy
Follow-up request for perineal rehabilitation :
Urinary incontinenceFecal incontinencePelvic floor weaknessVaginal painVaginal/anal hypertoniaEnuresisAnismBladder overactivityDyssynergia / pseudo dyssynergia VSPelvic prolapseEncopresisPregnancy monitoring in physiotherapyPessary (assessment, installation and monitoring)Constipation disordersNeurological damage
Pediatric follow-up request :
Developmental delayTorticollisPlagiocephalyGait disorderNeurological impairment/injuryMusculoskeletal impairment/injuryDyspraxia
Man specific tracking request :
Peyronie's diseaseErectile dysfunction, teaching of intracavernosal injectionsChronic painful prostate syndromePre-post prostatectomy education
Particularities of the evaluation and examination results :
Please refer this patient to the Cigonia clinic.
Date :
Signature :