Reservationadmin2016-12-24T13:14:15+00:00

Online Reservation

Family information

• Surname *
• Name of the mother : *
• Name of the father :
• Phone *
• Email *
• Address
  Street AddressApt, Suite, Bldg. (optional)ŞehirEyalet / İl / BölgePosta / posta koduAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweÜlke

Informationen about the child

• Name of the patient :
• Date of birth :
• Name of the disease
• Age :
• Size :
• Weight :

Does the child need help at the fields mentioned below?

• Toilet :
  YesNo
• Sitting :
  YesNo
• Eating :
  YesNo
• Standing :
  YesNo
• Getting Dressed :
  YesNo
• Locomotion :
  YesNoOption 3

Please answer the questions given below.

• Does the child need special devices?(If so, please provide more detailed information)
• How would the child react to "No, you cannot do it/get it now!"
• Can the child stretch his/her legs?
• Can the child swallow?
• Is the child under medical treatment? (If so, which medecines, when and in which intervals does the medication take place, for what purpose and how. Please provide detailed information )
• Strengths and weaknesses of the child?
• Is the child afraid of big animals and deep water?
• Can the child swim?
• Can the child use swimming goggles?
• Does the child allow foreign persons to touch and hug him/her?
• Does the child suffer from visual disorder? ( If so, please provide detailed information.)
• Can the child hear?
• Can the child follow simple instructions?
• Which goals and expectations do you have concerning your child?
• What do you know about the dolphin therapy?
• How did you become aware of our activities?
• Which therapy types were tried before and what were the results?
• Does the child have brothers and sisters (if so, please tell us their sex, age and expectations)

Please determine the frequency that fits best. %0 never - %25 sometimes - %50 often - %75 quite often - %100 always

• Can the child move his head in a controlled way?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Does he/she behave in a way, which could inflict harm upon himself/herself? (biting, scratching,beating)
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Does he/she have choleric outbursts?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Can the child move his head in a controlled way?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Does your child behave in an aggressive way?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Can he/she create sounds?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Can he/she create words and/or sentences?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Does he/she have an allergy?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Does he/she use the sign language?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Does the child use another form of communication?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• If so, please describe those communication form(s)?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Does he/she answer, if called by his/her name?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Can he/she follow instructions?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Does he/she recognize changes in the environment?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Is he/she hypersensitive against sunbeams and/or heat?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• Can he/she use a language for communication?
  %0 Never%25 Sometimes%50 Often%75 Quite Often%100 Always
• If allergies exist, please name them.
• Where will you stay in Antalya?
• Please determine the required period for the therapy, and add, if necessary, any kind of further information.

 

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