{"id":155,"date":"2014-01-31T11:38:39","date_gmt":"2014-01-31T11:38:39","guid":{"rendered":"http:\/\/www.waddenweg.nl\/demo\/?page_id=155"},"modified":"2020-12-03T22:39:34","modified_gmt":"2020-12-03T21:39:34","slug":"inschrijving-nieuwe-patienten","status":"publish","type":"page","link":"https:\/\/www.waddenweg.nl\/index.php\/inschrijving-nieuwe-patienten\/","title":{"rendered":"Inschrijving nieuwe pati\u00ebnten"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_1' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Inschrijving <\/h3>\n                            <p class='gform_description'>Inschrijven nieuwe pati\u00ebnten <\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/index.php\/wp-json\/wp\/v2\/pages\/155' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_1_1\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_1\"><label class='gfield_label gform-field-label'  >Achternaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_name'>\n                                    <input name='input_1' id='input_1_1' type='text' value='' class='small'   aria-required=\"true\" aria-invalid=\"false\"   \/>\n                                <\/div><\/li><li id=\"field_1_2\"  class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_2\"><label class='gfield_label gform-field-label'  >Voorletter(s)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_name'>\n                                    <input name='input_2' id='input_1_2' type='text' value='' class='small'   aria-required=\"true\" aria-invalid=\"false\"   \/>\n                                <\/div><\/li><li id=\"field_1_3\"  class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_3\"><label class='gfield_label gform-field-label'  >Voorvoegsel<\/label><div class='ginput_container ginput_container_name'>\n                                    <input name='input_3' id='input_1_3' type='text' value='' class='small'    aria-invalid=\"false\"   \/>\n                                <\/div><\/li><li id=\"field_1_5\"  class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_5\"><label class='gfield_label gform-field-label'  >Roepnaam<\/label><div class='ginput_container ginput_container_name'>\n                                    <input name='input_5' id='input_1_5' type='text' value='' class='small'    aria-invalid=\"false\"   \/>\n                                <\/div><\/li><li id=\"field_1_8\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_8\"><label class='gfield_label gform-field-label'  >Geslacht<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_8'>\n\t\t\t<li class='gchoice gchoice_1_8_0'>\n\t\t\t\t<input name='input_8' type='radio' value='Man'  id='choice_1_8_0'    \/>\n\t\t\t\t<label for='choice_1_8_0' id='label_1_8_0' class='gform-field-label gform-field-label--type-inline'>Man<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_8_1'>\n\t\t\t\t<input name='input_8' type='radio' value='Vrouw'  id='choice_1_8_1'    \/>\n\t\t\t\t<label for='choice_1_8_1' id='label_1_8_1' class='gform-field-label gform-field-label--type-inline'>Vrouw<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_7\"  class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_7\"><label class='gfield_label gform-field-label'  >Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div id='input_1_7' class='ginput_container ginput_complex gform-grid-row'><div class=\"clear-multi\"><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_1_7_2_container'><select name='input_7[]' id='input_1_7_2'   aria-required='true'  ><option value=''>DD<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_1_7_1_container'><select name='input_7[]' id='input_1_7_1'   aria-required='true'  ><option value=''>MM<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_1_7_3_container'><select name='input_7[]' id='input_1_7_3'   aria-required='true'  ><option value=''>YYYY<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/div><\/li><li id=\"field_1_23\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_23\"><label class='gfield_label gform-field-label' for='input_1_23' >BSN nummer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_10\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_10\"><label class='gfield_label gform-field-label' for='input_1_10' >Straat<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_1_10' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_13\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_13\"><label class='gfield_label gform-field-label' for='input_1_13' >Huisnummer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_1_13' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_9\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_9\"><label class='gfield_label gform-field-label' for='input_1_9' >Postcode<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_14\"  class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_14\"><label class='gfield_label gform-field-label' for='input_1_14' >Woonplaats<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_1_14' type='text' value='' class='small'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_1_17\"  class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_17\"><label class='gfield_label gform-field-label' for='input_1_17' >Mobiel nummer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_17' id='input_1_17' type='tel' value='' class='small'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_15\"  class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_15\"><label class='gfield_label gform-field-label' for='input_1_15' >Tel. thuis<\/label><div class='ginput_container ginput_container_phone'><input name='input_15' id='input_1_15' type='tel' value='' class='small'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_18\"  class=\"gfield gfield--type-email field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_18\"><label class='gfield_label gform-field-label' for='input_1_18' >E-mailadres<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_18' id='input_1_18' type='email' value='' class='small'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_1_43\"  class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_43\"><label class='gfield_label gform-field-label' for='input_1_43' >Verzekeraar<\/label><div class='ginput_container ginput_container_phone'><input name='input_43' id='input_1_43' type='tel' value='' class='small'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_44\"  class=\"gfield gfield--type-phone field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_44\"><label class='gfield_label gform-field-label' for='input_1_44' >Polisnummer<\/label><div class='ginput_container ginput_container_phone'><input name='input_44' id='input_1_44' type='tel' value='' class='small'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_1_22\"  class=\"gfield gfield--type-radio gfield--type-choice field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_22\"><label class='gfield_label gform-field-label'  >Bent u verzekerd tegen tandheelkundige kosten?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_22'>\n\t\t\t<li class='gchoice gchoice_1_22_0'>\n\t\t\t\t<input name='input_22' type='radio' value='Ja'  id='choice_1_22_0'    \/>\n\t\t\t\t<label for='choice_1_22_0' id='label_1_22_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_22_1'>\n\t\t\t\t<input name='input_22' type='radio' value='Nee'  id='choice_1_22_1'    \/>\n\t\t\t\t<label for='choice_1_22_1' id='label_1_22_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_24\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_24\"><label class='gfield_label gform-field-label' for='input_1_24' >Wie is uw huidige tandarts of wie was uw tandarts?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_24' id='input_1_24' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_41\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_41\"><h2 class=\"gsection_title\">Om te weten wat u van ons verwacht ontvangen wij graag de volgende informatie:<\/h2><\/li><li id=\"field_1_31\"  class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_31\"><label class='gfield_label gform-field-label' for='input_1_31' >Heeft u nu problemen of klachten aan uw gebit?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_31' id='input_1_31' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_27\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_27\"><label class='gfield_label gform-field-label'  >Hoe belangrijk is uw gebit voor u?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_27'>\n\t\t\t<li class='gchoice gchoice_1_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Niet belangrijk'  id='choice_1_27_0'    \/>\n\t\t\t\t<label for='choice_1_27_0' id='label_1_27_0' class='gform-field-label gform-field-label--type-inline'>Niet belangrijk<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='Belangrijk'  id='choice_1_27_1'    \/>\n\t\t\t\t<label for='choice_1_27_1' id='label_1_27_1' class='gform-field-label gform-field-label--type-inline'>Belangrijk<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_27_2'>\n\t\t\t\t<input name='input_27' type='radio' value='Zeer belangrijk'  id='choice_1_27_2'    \/>\n\t\t\t\t<label for='choice_1_27_2' id='label_1_27_2' class='gform-field-label gform-field-label--type-inline'>Zeer belangrijk<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_28\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_28\"><label class='gfield_label gform-field-label'  >Hoe gezond vindt u nu uw tandvlees op een schaal van 1 tot 9 waarbij 1 heel ongezond en 9 heel gezond is? Graag uw cijfer.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_28'>\n\t\t\t<li class='gchoice gchoice_1_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='1'  id='choice_1_28_0'    \/>\n\t\t\t\t<label for='choice_1_28_0' id='label_1_28_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='3'  id='choice_1_28_1'    \/>\n\t\t\t\t<label for='choice_1_28_1' id='label_1_28_1' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_28_2'>\n\t\t\t\t<input name='input_28' type='radio' value='5'  id='choice_1_28_2'    \/>\n\t\t\t\t<label for='choice_1_28_2' id='label_1_28_2' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_28_3'>\n\t\t\t\t<input name='input_28' type='radio' value='7'  id='choice_1_28_3'    \/>\n\t\t\t\t<label for='choice_1_28_3' id='label_1_28_3' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_28_4'>\n\t\t\t\t<input name='input_28' type='radio' value='9'  id='choice_1_28_4'    \/>\n\t\t\t\t<label for='choice_1_28_4' id='label_1_28_4' class='gform-field-label gform-field-label--type-inline'>9<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_29\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_29\"><label class='gfield_label gform-field-label'  >Hoe sterk vindt u nu uw gebit op een schaal van 1 tot 9 waarbij 1 heel zwak en 9 heel sterk is?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_29'>\n\t\t\t<li class='gchoice gchoice_1_29_0'>\n\t\t\t\t<input name='input_29' type='radio' value='1'  id='choice_1_29_0'    \/>\n\t\t\t\t<label for='choice_1_29_0' id='label_1_29_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_29_1'>\n\t\t\t\t<input name='input_29' type='radio' value='3'  id='choice_1_29_1'    \/>\n\t\t\t\t<label for='choice_1_29_1' id='label_1_29_1' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_29_2'>\n\t\t\t\t<input name='input_29' type='radio' value='5'  id='choice_1_29_2'    \/>\n\t\t\t\t<label for='choice_1_29_2' id='label_1_29_2' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_29_3'>\n\t\t\t\t<input name='input_29' type='radio' value='7'  id='choice_1_29_3'    \/>\n\t\t\t\t<label for='choice_1_29_3' id='label_1_29_3' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_29_4'>\n\t\t\t\t<input name='input_29' type='radio' value='9'  id='choice_1_29_4'    \/>\n\t\t\t\t<label for='choice_1_29_4' id='label_1_29_4' class='gform-field-label gform-field-label--type-inline'>9<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_30\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_30\"><label class='gfield_label gform-field-label'  >Hoe mooi vindt u nu uw gebit op een schaal van 1 tot 9 waarbij 1 heel lelijk is en 9 heel mooi is. Graag uw cijfer.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_30'>\n\t\t\t<li class='gchoice gchoice_1_30_0'>\n\t\t\t\t<input name='input_30' type='radio' value='1'  id='choice_1_30_0'    \/>\n\t\t\t\t<label for='choice_1_30_0' id='label_1_30_0' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_1'>\n\t\t\t\t<input name='input_30' type='radio' value='3'  id='choice_1_30_1'    \/>\n\t\t\t\t<label for='choice_1_30_1' id='label_1_30_1' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_2'>\n\t\t\t\t<input name='input_30' type='radio' value='5'  id='choice_1_30_2'    \/>\n\t\t\t\t<label for='choice_1_30_2' id='label_1_30_2' class='gform-field-label gform-field-label--type-inline'>5<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_3'>\n\t\t\t\t<input name='input_30' type='radio' value='7'  id='choice_1_30_3'    \/>\n\t\t\t\t<label for='choice_1_30_3' id='label_1_30_3' class='gform-field-label gform-field-label--type-inline'>7<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_30_4'>\n\t\t\t\t<input name='input_30' type='radio' value='9'  id='choice_1_30_4'    \/>\n\t\t\t\t<label for='choice_1_30_4' id='label_1_30_4' class='gform-field-label gform-field-label--type-inline'>9<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_42\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_42\"><h2 class=\"gsection_title\">Omdat er een wisselwerking is tussen uw gezondheid en een tandheelkundige behandeling vragen wij naar uw gezondheid:<\/h2><\/li><li id=\"field_1_33\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_33\"><label class='gfield_label gform-field-label'  >Bent u momenteel onder medische behandeling of controle?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_33'>\n\t\t\t<li class='gchoice gchoice_1_33_0'>\n\t\t\t\t<input name='input_33' type='radio' value='Ja'  id='choice_1_33_0'    \/>\n\t\t\t\t<label for='choice_1_33_0' id='label_1_33_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_33_1'>\n\t\t\t\t<input name='input_33' type='radio' value='Nee'  id='choice_1_33_1'    \/>\n\t\t\t\t<label for='choice_1_33_1' id='label_1_33_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_34\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_34\"><label class='gfield_label gform-field-label' for='input_1_34' >Zo ja, waarvoor?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_34' id='input_1_34' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_36\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_36\"><label class='gfield_label gform-field-label'  >Gebruikt u medicijnen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_36'>\n\t\t\t<li class='gchoice gchoice_1_36_0'>\n\t\t\t\t<input name='input_36' type='radio' value='Ja'  id='choice_1_36_0'    \/>\n\t\t\t\t<label for='choice_1_36_0' id='label_1_36_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_36_1'>\n\t\t\t\t<input name='input_36' type='radio' value='Nee'  id='choice_1_36_1'    \/>\n\t\t\t\t<label for='choice_1_36_1' id='label_1_36_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_37\"  class=\"gfield gfield--type-textarea field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_37\"><label class='gfield_label gform-field-label' for='input_1_37' >Zo ja, waarvoor?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_37' id='input_1_37' class='textarea small'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_1_26\"  class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_26\"><label class='gfield_label gform-field-label'  >Hoe bent u bij onze praktijk terechtgekomen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_1_26'>\n\t\t\t<li class='gchoice gchoice_1_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='via vrienden, familie'  id='choice_1_26_0'    \/>\n\t\t\t\t<label for='choice_1_26_0' id='label_1_26_0' class='gform-field-label gform-field-label--type-inline'>via vrienden, familie<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='via google'  id='choice_1_26_1'    \/>\n\t\t\t\t<label for='choice_1_26_1' id='label_1_26_1' class='gform-field-label gform-field-label--type-inline'>via google<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_26_2'>\n\t\t\t\t<input name='input_26' type='radio' value='verwezen of aanbevolen door tandarts'  id='choice_1_26_2'    \/>\n\t\t\t\t<label for='choice_1_26_2' id='label_1_26_2' class='gform-field-label gform-field-label--type-inline'>verwezen of aanbevolen door tandarts<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_1_26_3'>\n\t\t\t\t<input name='input_26' type='radio' value='anders,'  id='choice_1_26_3'    \/>\n\t\t\t\t<label for='choice_1_26_3' id='label_1_26_3' class='gform-field-label gform-field-label--type-inline'>anders,<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_1_35\"  class=\"gfield gfield--type-text field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_35\"><label class='gfield_label gform-field-label' for='input_1_35' >namelijk:<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_1_35' type='text' value='' class='small'      aria-invalid=\"false\"   \/> <\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_1' class='gform_button button' value='Verzenden'  onclick='if(window[\"gf_submitting_1\"]){return false;}  if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_1\"]){return false;} if( !jQuery(\"#gform_1\")[0].checkValidity || jQuery(\"#gform_1\")[0].checkValidity()){window[\"gf_submitting_1\"]=true;}  jQuery(\"#gform_1\").trigger(\"submit\",[true]); }' \/> \n            <input type='hidden' class='gform_hidden' name='is_submit_1' value='1' \/>\n            <input 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*\/\n<\/script>\n\n","protected":false},"excerpt":{"rendered":"Inschrijving Inschrijven nieuwe pati\u00ebnten Achternaam* Voorletter(s)* Voorvoegsel Roepnaam Geslacht* Man Vrouw Geboortedatum*DD12345678910111213141516171819202122232425262728293031MM123456789101112YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920BSN nummer* Straat* Huisnummer* Postcode* Woonplaats* Mobiel nummer*Tel. thuisE-mailadres VerzekeraarPolisnummerBent u verzekerd tegen tandheelkundige kosten? Ja Nee Wie is [...]","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"rs_blank_template":"","rs_page_bg_color":"#ffffff","slide_template_v7":"","footnotes":""},"class_list":["post-155","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.waddenweg.nl\/index.php\/wp-json\/wp\/v2\/pages\/155","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.waddenweg.nl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.waddenweg.nl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.waddenweg.nl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.waddenweg.nl\/index.php\/wp-json\/wp\/v2\/comments?post=155"}],"version-history":[{"count":1,"href":"https:\/\/www.waddenweg.nl\/index.php\/wp-json\/wp\/v2\/pages\/155\/revisions"}],"predecessor-version":[{"id":156,"href":"https:\/\/www.waddenweg.nl\/index.php\/wp-json\/wp\/v2\/pages\/155\/revisions\/156"}],"wp:attachment":[{"href":"https:\/\/www.waddenweg.nl\/index.php\/wp-json\/wp\/v2\/media?parent=155"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}