Thank you for Your Trust

This survey is dedicated to those who have already been patients at Olinka. By completing it, you will help us better tailor the schedule to your preferences. We invite you to sign up for a session at Olinka:

Patient's Full Name

Your Email Address

Phone Number

Child's Weight in Kilograms

Child's Height in Centimeters

Preferred Start Date of Session
Days we don't work
2026: 06.04, 01.05, 24.05, 04.06, 15.08, 01.11, 11.11, 21.12 - 05.01.2027

Preferred End Date of Session

We operate from 8 AM to 5 PM - What hours can your child attend sessions? Check the hours (multiple choice field)
8-1010-1212-1414-16

Does your child need breaks between therapies?
YesNo

Which therapies does your child want to participate in during the session? Choose therapies and the number of hours.

Physical Therapy / Functional Therapy

NDT Bobath Baby for Premature and Infants

Hand Therapy

Sensory Integration

Strength Training

Neurologopedist

Vision Therapy

Psychologist

RoboGait
G-EO System
Prof. A. Tomatis Therapy Stage I
Prof. A. Tomatis Therapy Stage II or subsequent
INDIBA
Prodrobot / Innowalk
Hyperbaric Chamber
Osteopath
Stochastic Resonance - Additional +40 PLN to the basic therapy price
Classic Massage (for a parent)

Do you have any preferred therapists? If yes, please mark them on the form (select at least a few therapists)
Yes, I have preferred therapistsNo, match therapists to my schedule

NOTES – important for the next session that the therapist should know

Reccomendation from (parent's first and last name)