Book an appointment
Phone
  • Phone
  • For doctors
  • Book an appointment
  • Contact
  • Jobs
  • News / Events
  • International Patients
  • Blog
EN FR
MENU
  • Hospitals
    back

    Hospitals

    Hospitals
      French-speaking Switzerland
    • Clinique de Genolier
    • Clinique de Montchoisi - Lausanne
    • Clinique de Valère - Sion
    • Clinique Générale Ste-Anne - Fribourg
    • Clinique Générale-Beaulieu - Geneva
    • Clinique Montbrillant - Chaux-de-Fonds
    • Clinique Valmont - Glion sur Montreux
    • Hôpital de La Providence - Neuchâtel
    • Hôpital de Moutier
    • Hôpital de Saint-Imier
      • German-speaking Switzerland
    • Privatklinik Belair
    • Privatklinik Bethanien - Zürich
    • Privatklinik Lindberg - Winterthur
    • Privatklinik Obach - Solothurn
    • Privatklinik Siloah
    • Privatklinik Villa im Park, Rothrist
    • Rosenklinik Rapperswil
    • Schmerzklinik Basel
    • Spital Zofingen
      • Ticino
    • Clinica Ars Medica - Gravesano
    • Clinica Sant'Anna - Sorengo
  • Centres
    back

    Centres

    Centres
      French-speaking Switzerland
    • Centre Médical Eaux-Vives
    • Centre Médical Valère
    • Consultations dans le Haut Valais
    • Médicentre Corgémont
    • Medicentre Courtelary
    • Médicentre Moutier
    • Médicentre Tavannes
    • Medicentre Valbirse
      • Medicentre Valbirse
      • Offer
      • Medical specialty
      • Doctors Directory
      • Mission, vision, valeurs
    • Montchoisi Medical Center
    • Policlinique de Valère
    • Polyclinic Genolier
      • German-speaking Switzerland
    • Ärztezentrum Bümpliz
    • Ärztezentrum Ittigen
    • Ärztezentrum Oerlikon
    • Ärztezentrum Ostermundigen
    • Ärztezentrum Schönburg
    • Ärztezentrum Siloah Liebefeld
    • Ärztezentrum Siloah Murten
    • Ärztezentrum Solothurn
    • Ladies Permanence Stadelhofen
    • Medizinisches Zentrum Biel
    • Medizinisches Zentrum Haus zur Pyramide
    • Xundheitszentrum
      • Xundheitszentrum
      • Beromünster
      • Escholzmatt
      • Egerkingen
      • Reinach
      • Grindelwald
      • Wengen
      • Schaffhausen
      • Stein am Rhein
      • Silvaplana
      • ‎ Seewadel
      • Ticino
    • Ars Medica Agno
    • Ars Medica Bellinzona
    • Ars Medica Manno
    • Blenio
    • Centromedico
      • Centromedico
      • Chiasso
      • Locarno
      • Cugnasco
      • Stabio
      • Lugano
      • Bellinzona
      • Mendrisio
      • Lugano Centro
      • Faido
      • Claro
    • Medicentro Pediatrico
    • Medicentro Sant'Anna
      • Specialised centres
    • Cancer centres
    • Radiology centres
    • Spine centres
    • Sports medicine centres
    • Neurology centres
    • Centre du Sein
      • Centre du Sein
      • Breast Cancer Symptoms and Early Detection
      • Breast Cancer Diagnosis
      • Breast Cancer Treatment
      • Breast Cancer Aftercare
      • Breast Cancer Prevention
  • Swiss Visio
  • Medical specialty
  • Doctors
  • For patients
    back

    For patients

    For patients
    • Hospitality
      • Hospitality
      • Caffè Carlito
    • International patients
    • Swiss domiciled patients
  • About us
    back

    About us

    About us
    • Bee Sustainable
    • Board of Directors
    • Management
    • Medical infrastructure
    • Philosophy
    • Quality management
    • Science and Innovation
      • Science and Innovation
      • Clinical and translational research
  • Integrated care
    back

    Integrated care

    Integrated care
    • Aare-Netz
    • Réseau de l'Arc
    • Rete Sant'Anna
EN FR
  • Hospitals
    back

    Hospitals

    Hospitals
    • Clinica Ars Medica - Gravesano
    • Clinica Sant'Anna - Sorengo
    • Clinique de Genolier
    • Clinique de Montchoisi - Lausanne
    • Clinique de Valère - Sion
    • Clinique Générale Ste-Anne - Fribourg
    • Clinique Générale-Beaulieu - Geneva
    • Clinique Montbrillant - Chaux-de-Fonds
    • Clinique Valmont - Glion sur Montreux
    • Hôpital de La Providence - Neuchâtel
    • Hôpital de Moutier
    • Hôpital de Saint-Imier
    • International Patients
      • International Patients
      • Information & Services
      • Our Hospitals
      • Medical Services
      • Team
      • Contact us
      • Media
    • Privatklinik Belair
    • Privatklinik Bethanien - Zürich
    • Privatklinik Lindberg - Winterthur
    • Privatklinik Obach - Solothurn
    • Privatklinik Siloah
    • Privatklinik Villa im Park, Rothrist
    • Rosenklinik Rapperswil
    • Schmerzklinik Basel
    • Spital Zofingen
  • Centres
    back

    Centres

    Centres
    • Ars Medica Agno
    • Ars Medica Bellinzona
    • Ars Medica Manno
    • Ärztezentrum Bümpliz
    • Ärztezentrum Ittigen
    • Ärztezentrum Oerlikon
    • Ärztezentrum Ostermundigen
    • Ärztezentrum Schönburg
    • Ärztezentrum Siloah Liebefeld
    • Ärztezentrum Siloah Murten
    • Ärztezentrum Solothurn
    • Blenio
    • Centre Médical Eaux-Vives
    • Centre Médical Valère
    • Centromedico
      • Centromedico
      • Chiasso
      • Locarno
      • Cugnasco
      • Stabio
      • Lugano
      • Bellinzona
      • Mendrisio
      • Lugano Centro
      • Faido
      • Claro
    • Consultations dans le Haut Valais
    • Ladies Permanence Stadelhofen
    • Médicentre Corgémont
    • Medicentre Courtelary
    • Médicentre Moutier
    • Médicentre Tavannes
    • Medicentre Valbirse
      • Medicentre Valbirse
      • Offer
      • Medical specialty
      • Doctors Directory
      • Mission, vision, valeurs
    • Medicentro Pediatrico
    • Medicentro Sant'Anna
    • Medizinisches Zentrum Biel
    • Medizinisches Zentrum Haus zur Pyramide
    • Montchoisi Medical Center
    • Policlinique de Valère
    • Polyclinic Genolier
    • Xundheitszentrum
      • Xundheitszentrum
      • Beromünster
      • Escholzmatt
      • Egerkingen
      • Reinach
      • Grindelwald
      • Wengen
      • Schaffhausen
      • Stein am Rhein
      • Silvaplana
      • ‎ Seewadel
    • Cancer centres
    • Radiology centres
    • Spine centres
    • Sports medicine centres
    • Neurology centres
    • Centre du Sein
      • Centre du Sein
      • Breast Cancer Symptoms and Early Detection
      • Breast Cancer Diagnosis
      • Breast Cancer Treatment
      • Breast Cancer Aftercare
      • Breast Cancer Prevention
  • Swiss Visio
  • Medical specialty
  • Doctors
  • For patients
    back

    For patients

    For patients
    • Hospitality
      • Hospitality
      • Caffè Carlito
    • International patients
    • Swiss domiciled patients
  • About us
    back

    About us

    About us
    • Bee Sustainable
    • Board of Directors
    • Management
    • Medical infrastructure
    • Philosophy
    • Quality management
    • Science and Innovation
      • Science and Innovation
      • Clinical and translational research
  • Integrated care
    back

    Integrated care

    Integrated care
    • Aare-Netz
    • Réseau de l'Arc
    • Rete Sant'Anna
  • Phone
  • For doctors
  • Contact
  • Jobs
  • News / Events
  • Book an appointment
  • International Patients
  • Blog
EN FR
close search

How can we help you?

Top searches

Jobs
Radiology
Physiotherapy
Oncology
Apprenticeship
Management
Gynecology
Ergotherapy
Radiotherapy
Mri
Neurology
Neursurgery
Show all suggestions
Clinique de Montchoisi

Prix de Lausanne’s medical questionnaire

Prix de Lausanne’s medical process consists of an online medical form asking thorough questions regarding the dancer’s overall health. Please plan ahead and make an appointment with your doctor during the month of September as you will need to complete the online medical form along with your doctor.

Growth diagram

To complete your registration, please download the document below.

Only the following Prix de Lausanne’s diagram will be accepted, not a version of your physician.

Please upload the completed document in section 2 of the online questionnaire

Download the growth diagram

Medical questionnaire

Please answer every question in the presence of your medical practitioner.

After completing the form, if you are not redirected to a confirmation page, it means that one or more mandatory fields have not been filled in. If you are redirected, your form has been successfully submitted and received by the medical team.

Please note that all correctly completed forms will be confirmed by an automatic e-mail.
If this is not the case, we ask you to check that all the fields on the form have been filled in.

1. Dance training
2. Physical development

Please indicate on the attached diagram the known data regarding the weight and height of the candidate during his/her growth

3. Family history
4. Personal history
a. Surgical
b. Medical

Have you ever had any of the following?

c. Allergies

Do you have any of the following ?

d. Injuries

Have you ever had: (please specify where and the date)

e. Medications
5. Bone Health
a. Menstruation
b. Bone injuries
c. Nutritional behaviour
6. Eating Attitude Test
7. Mental health status

These questions relate to the past 30 days

8. Current state of Health

If YES, please fill in the questions below.

9. Conclusion

To be filled by the medical practitioner

The personal data collected on this form will be sent to MotionLab SA, the medical partner of the Prix de Lausanne. It will be used by MotionLab SA to assess the state of health of candidates and to provide medical support to selected candidates during the event. This data will be processed in accordance with MotionLab SA's data protection declaration. This personal data may be passed on, in anonymised form, to the Fondation en faveur de l'Art Chorégraphique, organiser of the Prix de Lausanne, for statistical and research purposes.

I hereby confirm that the information I have provided is correct and that Swiss Medical Network can provide me with relevant information in the context of my request and thus accept the privacy policy.
I would like to receive the newest updates and information from the Swiss Medical Network via Newsletter.