MOTOmed contact form

Find out more about the MOTOmed and a possible demonstration.
Information material
Please send me a complete information package about the MOTOmed Movement Therapy free of charge.
MOTOmed demonstration
I would like to convince myself from the benefits of the MOTOmed Movement Therapy by trying it out. Please make suggestions free of further obligations.
Please contact me:
 Fields marked with a * must be completed.
 *Ms. / Mr.  
 
 *Last name,
first name
  
 
  Occupation  
 
  Clinic,
institution
  
 
 *Street, no.   
 
 *Post /
Zip code
  
 
 *City/State  
 
 *Country  
 
 *E-Mail  
 
 Phone  
 
  Fax  
 
 *How did you learn about the MOTOmed?   
 
 Advertisement in the following newspaper/magazine  
 
 The following hospital/rehabilitation facility   
 
 The following rehabilitation facility  
 
 The following show  
 
 Link on the following website  
 
 Recommendation of an acquaintance   
 
 other  
 
  If you wish information material only, you can send your inquiry now.

  
 

Conditions

We would like to respond to your condition best possible. Therefore, please complete the following form. Of course it is up to you, which fields you like to complete. Your data will be treated confidentially.
 

Further symptoms
Muscular dystrophyBowel and bladder problems
Digestive disordersSleep disorders
Circulatory disorders
(cold, painful legs/feet)
Edema
(Water in the legs)
Other symptoms

Present therapy
Physiotherapy Occupation Therapy
MassageHippo Therapy
Durationx PT/week
Body sizein cm/inches
Health insurance
Date of birth

Special details or wishes
my representative


  



Hint


If you have concerns to transfer the data via the internet, please print the contact form and send it via
mail or
fax (+49-73 74-18 480).

In addition, the MOTOmed Customer Service Team will be pleased to assist you Phone:
+49-73 74-18 85 Monday to Friday 7.30 - 16.45 h.

Postal address:
RECK-Technik GmbH & Co. KG
Reckstrasse 1-4
88422 Betzenweiler, Germany


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