KEMER ANTALYA
DOLPHIN
Therapy
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DOLPHIN THERAPY
SERVICES & PRICES
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THERAPY APPLICATION FORM
Family and Contact Info
Family Name
Mothers Name
Fathers Name
Phone Number
E-mail address
Address
Patient Information
Patient Full Name
Birthday
Condition
Height
Weight
Can the patient do on his/her own?
Go to the toilet
Yes
No
Sit
Yes
No
Eat
Yes
No
Stand
Yes
No
Dress
Yes
No
Walk
Yes
No
Please answer the questions below.
Never
%0
Sometimes
%25
Often
%50
Frequently
%75
Always
%100
How good is the patients control over his/her head?
%0
%25
%50
%75
%100
Can the patient walk?
%0
%25
%50
%75
%100
Can the patient stretch out his/her arms?
%0
%25
%50
%75
%100
Can the patient hold objects?
%0
%25
%50
%75
%100
Is the patient scared when away from his/her family
%0
%25
%50
%75
%100
Does the patient show aggressive behavior?
%0
%25
%50
%75
%100
Does the patient have self-harming behavior?
%0
%25
%50
%75
%100
Can the patient say words and sentences?
%0
%25
%50
%75
%100
Is the patient afraid of animals?
%0
%25
%50
%75
%100
Is the patient afraid of being in the water?
%0
%25
%50
%75
%100
Does the patient have allergies?
Does the patient use/wear any medical devices?
Does the patient use a wheelchair?
Is the patient on any medication?
Does the patient have any visual impairments?
Does the patient have a hearing impairment?
Does the patient have epilepsy?
Have you been to dolphin therapy before?
Other notes
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How was Dolphin Therapy Land created?
Dolphin Therapy Process and Program
Dolphin Therapy Services Include
Dolphin Therapy Prices
Dolphin Therapy Travel
Photos and Videos
Therapy Team
Experiences of our Previous Therapy Families
Frequently Asked Questions
CONTACT : Turkey Office- German Office
Location