<style id="elementor-post-2258">.elementor-2258 .elementor-element.elementor-element-4ed36ed:not(.elementor-motion-effects-element-type-background), .elementor-2258 .elementor-element.elementor-element-4ed36ed > .elementor-motion-effects-container > .elementor-motion-effects-layer{background-color:#1B2A41;}.elementor-2258 .elementor-element.elementor-element-4ed36ed{box-shadow:0px 5px 10px 0px rgba(0,0,0,0.5);transition:background 0.3s, border 0.3s, border-radius 0.3s, box-shadow 0.3s;margin-top:0%;margin-bottom:03%;padding:01% 0% 1% 0%;}.elementor-2258 .elementor-element.elementor-element-4ed36ed > .elementor-background-overlay{transition:background 0.3s, border-radius 0.3s, opacity 0.3s;}.elementor-2258 .elementor-element.elementor-element-b10bca1{margin-top:0px;margin-bottom:0px;padding:0px 0px 0px 0px;}.elementor-widget-heading .elementor-heading-title{color:var( --e-global-color-primary );}.elementor-2258 .elementor-element.elementor-element-14724f4 > .elementor-widget-container{background-color:#1B2A4100;padding:1% 0% 0% 0%;}.elementor-2258 .elementor-element.elementor-element-14724f4 .elementor-heading-title{font-family:"AGBook2", AGBook2;font-size:62px;font-weight:600;text-transform:none;color:#FFFFFF;}.elementor-2258 .elementor-element.elementor-element-98331c9.elementor-column > .elementor-widget-wrap{justify-content:center;}@media(max-width:767px){.elementor-2258 .elementor-element.elementor-element-14724f4 > .elementor-widget-container{padding:10px 0px 0px 10px;}.elementor-2258 .elementor-element.elementor-element-14724f4 .elementor-heading-title{font-size:28px;}}/* Start Custom Fonts CSS */@font-face {
	font-family: 'AGBook2';
	font-style: normal;
	font-weight: normal;
	font-display: auto;
	src: url('https://doktorbabendererde.de/wp-content/uploads/2021/01/AGBooRouMedNew.woff2') format('woff2'),
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/* End Custom Fonts CSS */</style>{"id":2258,"date":"2021-09-20T14:15:28","date_gmt":"2021-09-20T12:15:28","guid":{"rendered":"https:\/\/doktorbabendererde.de\/?page_id=2258"},"modified":"2024-09-02T19:26:18","modified_gmt":"2024-09-02T17:26:18","slug":"bordpapiere-uebermitteln","status":"publish","type":"page","link":"https:\/\/doktorbabendererde.de\/ru\/bordpapiere-uebermitteln\/","title":{"rendered":"\u0417\u0430\u043f\u043e\u043b\u043d\u0438\u0442\u0435 \u043f\u043e\u0441\u0430\u0434\u043e\u0447\u043d\u044b\u0435 \u0434\u043e\u043a\u0443\u043c\u0435\u043d\u0442\u044b \u043e\u043d\u043b\u0430\u0439\u043d"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2258\" class=\"elementor elementor-2258\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4ed36ed elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"4ed36ed\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f356018\" data-id=\"f356018\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-b10bca1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b10bca1\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-050f5a8\" data-id=\"050f5a8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-14724f4 elementor-widget elementor-widget-heading\" data-id=\"14724f4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Bordpapiere online ausf\u00fcllen<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-73a5340 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"73a5340\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-98331c9\" data-id=\"98331c9\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-a19bc73 elementor-widget elementor-widget-shortcode\" data-id=\"a19bc73\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2263-o1\" lang=\"de-DE\" dir=\"ltr\" data-wpcf7-id=\"2263\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ru\/wp-json\/wp\/v2\/pages\/2258#wpcf7-f2263-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-no-moving-animation\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2263\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"de_DE\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2263-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"upload_dir\" value=\"tmp_uploads\" \/><input type=\"hidden\" name=\"generate_name\" value=\"09-24-26-6ab51f61eefab\" \/>\n<\/fieldset>\n<link rel=\"stylesheet\" href=\"https:\/\/doktorbabendererde.de\/wp-content\/plugins\/pdf-forms-for-contact-form-7\/css\/frontend.css\" \/><script type=\"text\/javascript\" src=\"https:\/\/doktorbabendererde.de\/wp-content\/plugins\/pdf-forms-for-contact-form-7\/js\/frontend.js?ver=2.2.6\"><\/script><div class=\"fieldset-cf7mls-wrapper\" data-transition-effects=\"\"><fieldset class=\"fieldset-cf7mls cf7mls_current_fs\">\n<h3>Kundendaten:\n<\/h3>\n<p>Felder mit *-Markierungen stellen Pflichtfelder dar.\n<\/p>\n<p><label>Vor- und Nachname*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-name-vorname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-name-vorname\" \/><\/span>\n<\/p>\n<p><label>Stra\u00dfe und Hausummer*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-strasse-nummer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-strasse-nummer\" \/><\/span>\n<\/p>\n<p><label>PLZ und Ort*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-plz-ort\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-plz-ort\" \/><\/span>\n<\/p>\n<p><label>Gesundheitskasse*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-krankenkasse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-krankenkasse\" \/><\/span>\n<\/p>\n<p><label>Handelt es sich um eine private Krankenversicherung?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-privat1\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-privat1[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-privat1[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Beruf \/ Arbeitgeber*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-beruf\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-beruf\" \/><\/span>\n<\/p>\n<p><label>Geburtsdatum*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-geburtstag\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-geburtstag\" \/><\/span>\n<\/p>\n<p><label>E-Mail*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-e-mail\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"textfeld-e-mail\" \/><\/span>\n<\/p>\n<p><label>Telefon*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-telefon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-telefon\" \/><\/span>\n<\/p>\n<p><label>Mobil<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-mobil\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-mobil\" \/><\/span><br \/>\n<div class=\"cf7mls-btns\"><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-1\">Weiter<img decoding=\"async\" src=\"https:\/\/doktorbabendererde.de\/wp-content\/plugins\/contact-form-7-multi-step-pro\/\/assets\/frontend\/img\/loader.svg\" alt=\"\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<h3>Versicherter bzw. Ansprechpartner bei Minderj\u00e4hrigen:\n<\/h3>\n<p><label>Vor- und Nachname<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"minder-name\" \/><\/span>\n<\/p>\n<p><label>Stra\u00dfe und Hausnummer<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-strasse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"minder-strasse\" \/><\/span>\n<\/p>\n<p><label>PLZ und Ort<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-plz\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"minder-plz\" \/><\/span>\n<\/p>\n<p><label>Beruf \/ Arbeitgeber<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-beruf\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"minder-beruf\" \/><\/span>\n<\/p>\n<p><label>Gesundheitskasse<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-kasse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"minder-kasse\" \/><\/span>\n<\/p>\n<p><label>Handelt es sich um eine Private Krankenversicherung?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-privat\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"minder-privat[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"minder-privat[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Geburtsdatum<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-geburt\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"minder-geburt\" \/><\/span>\n<\/p>\n<p><label>E-Mail<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"minder-email\" \/><\/span>\n<\/p>\n<p><label>Telefon<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-telefon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"minder-telefon\" \/><\/span>\n<\/p>\n<p><label>Mobil<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"minder-mobil\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"minder-mobil\" \/><\/span><div class=\"cf7mls-btns\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-2\">Zur\u00fcck<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-2\">Weiter<img decoding=\"async\" src=\"https:\/\/doktorbabendererde.de\/wp-content\/plugins\/contact-form-7-multi-step-pro\/\/assets\/frontend\/img\/loader.svg\" alt=\"\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<h3>Kundenfragen\n<\/h3>\n<p>Felder mit *-Markierungen stellen Pflichtfelder dar.\n<\/p>\n<p><label>Besteht eine Zahnzusatzversicherung?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-zahnzusatz\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-zahnzusatz[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-zahnzusatz[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Besteht Berechtigung auf Beihilfe?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-beihilfe\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-beihilfe[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-beihilfe[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wenn ja, welche?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-welche-berechtigung-beihilfe\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-welche-berechtigung-beihilfe\" \/><\/span>\n<\/p>\n<p><label>Wie ist der Name Ihres Zahnarztes?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-name-zahnarzt\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-name-zahnarzt\" \/><\/span>\n<\/p>\n<p><label>Wo ist Ihr Zahnarzt niedergelassen?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-ort-zahnarzt\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-ort-zahnarzt\" \/><\/span>\n<\/p>\n<p><label>Sind in den letzten 6 Monaten R\u00f6ntgenaufnahmen angefertigt worden?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-roentgenaufnahmen6monate\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-roentgenaufnahmen6monate[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-roentgenaufnahmen6monate[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wenn ja, wo und wann?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-roentgenaufnahmen-wann-wo\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-roentgenaufnahmen-wann-wo\" \/><\/span>\n<\/p>\n<p><label>Wurde schon eine kieferorthop\u00e4dische Beratung \/ Behandlung durchgef\u00fchrt?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-kfo-behandlung\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-kfo-behandlung[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-kfo-behandlung[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wenn ja, wo und wann?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-kfo-beratung-wann-wo\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-kfo-beratung-wann-wo\" \/><\/span>\n<\/p>\n<p><label>Wurden schon andere Familienmitglieder kieferorthop\u00e4disch behandelt?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-kfo-familie\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-kfo-familie[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-kfo-familie[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Was st\u00f6rt am meisten an Zahn- bzw. Kieferfehlstellung?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-was-stoert-an-kieferfehlstellung\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-was-stoert-an-kieferfehlstellung\" \/><\/span>\n<\/p>\n<p><label>Wird \/ Wurde am Daumen gelutscht? (nur bei Kindern)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-daumen\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-daumen[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-daumen[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wird \/ Wurde ein Schnuller benutzt? (nur bei Kindern)<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-schnuller\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-schnuller[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-schnuller[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wenn ja, wie lange?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-wie-lange-schnuller\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-wie-lange-schnuller\" \/><\/span>\n<\/p>\n<p><label>Wird mit den Z\u00e4hnen geknirscht oder gepresst?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-zahnknirschen\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-zahnknirschen[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-zahnknirschen[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wurden bei einem Unfall Z\u00e4hne oder Kiefer verletzt?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-unfall\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-unfall[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-unfall[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Bestehen \/ bestanden Beschwerden des Kiefergelenks, der Kaumuskulatur oder h\u00e4ufig Kopfschmerzen?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-kieferbeschwerden\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-kieferbeschwerden[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-kieferbeschwerden[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Bestehen Kau- oder Schluckbeschwerden?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-kaubeschwerden\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-kaubeschwerden[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-kaubeschwerden[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wird regelm\u00e4\u00dfig Individualprophylaxe \/ PZR durchgef\u00fchrt?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-pzr\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-pzr[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-pzr[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Liegt eine erschwerte Nasen- bzw. Mundatmung vor?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-schwereatmung\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-schwereatmung[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-schwereatmung[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Besteht \/ bestand ein Sprachfehler?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-sprachfehler\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-sprachfehler[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-sprachfehler[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wurden Mandeln oder Polypen entfernt?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-mandeln\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-mandeln[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-mandeln[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Liegen Allergien vor?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-allergien\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-allergien[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-allergien[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wenn ja, welche?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-welche-allergie\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-welche-allergie\" \/><\/span>\n<\/p>\n<p><label>Ben\u00f6tigen Sie regelm\u00e4\u00dfig Medikamente?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-regelmedikamente\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-regelmedikamente[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-regelmedikamente[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wenn ja, welche?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-welche-medikamente\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-welche-medikamente\" \/><\/span>\n<\/p>\n<p><div class=\"cf7mls-btns\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-3\">Zur\u00fcck<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-3\">Weiter<img decoding=\"async\" src=\"https:\/\/doktorbabendererde.de\/wp-content\/plugins\/contact-form-7-multi-step-pro\/\/assets\/frontend\/img\/loader.svg\" alt=\"\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<h3>Liegt eine der folgenden Erkrankungen vor?\n<\/h3>\n<p>Felder mit *-Markierungen stellen Pflichtfelder dar.\n<\/p>\n<p><label>Herz-Kreislaufst\u00f6rungen*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-herzkreislauf\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-herzkreislauf[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-herzkreislauf[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Diabetis*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-diabetis\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-diabetis[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-diabetis[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Asthma*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-asthma\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-asthma[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-asthma[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Blutgerinnungsst\u00f6rungen*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-blutgerinnung\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-blutgerinnung[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-blutgerinnung[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>ADS \/ ADHS*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-ads\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-ads[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-ads[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Autismus*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-autismus\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-autismus[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-autismus[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Epilepsie*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-epilepsie\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-epilepsie[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-epilepsie[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>HIV*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-hiv\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-hiv[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-hiv[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Tuberkolose*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-tuberkulose\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-tuberkulose[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-tuberkulose[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Rheuma*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-rheuma\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-rheuma[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-rheuma[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Rheuma in der Familie*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-rheumafamilie\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-rheumafamilie[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-rheumafamilie[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Sonstige Erkrankung?*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-sonstiges\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-sonstiges[]\" value=\"Ja\" \/><span class=\"wpcf7-list-item-label\">Ja<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-sonstiges[]\" value=\"Nein\" \/><span class=\"wpcf7-list-item-label\">Nein<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Wenn ja, welche sonstige Erkrankung?<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-welche-erkrankung\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-welche-erkrankung\" \/><\/span><br \/>\n<div class=\"cf7mls-btns\"><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-4\">Zur\u00fcck<\/button><button type=\"button\" class=\"cf7mls_next cf7mls_btn action-button\" name=\"cf7mls_next\" id=\"cf7mls-next-btn-cf7mls_step-4\">Weiter<img decoding=\"async\" src=\"https:\/\/doktorbabendererde.de\/wp-content\/plugins\/contact-form-7-multi-step-pro\/\/assets\/frontend\/img\/loader.svg\" alt=\"\" \/><\/button><\/div><p><\/p><\/fieldset><fieldset class=\"fieldset-cf7mls\">\n<\/p>\n<h3>Wie sind Sie auf uns Aufmerksam geworden?\n<\/h3>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-388\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-388[]\" value=\"Zahn\u00e4rztliche Empfehlung\" \/><span class=\"wpcf7-list-item-label\">Zahn\u00e4rztliche Empfehlung<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-388[]\" value=\"Google\" \/><span class=\"wpcf7-list-item-label\">Google<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-388[]\" value=\"Bekannte \/ Verwandte\" \/><span class=\"wpcf7-list-item-label\">Bekannte \/ Verwandte<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-388[]\" value=\"Instagram\" \/><span class=\"wpcf7-list-item-label\">Instagram<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-388[]\" value=\"Facebook\" \/><span class=\"wpcf7-list-item-label\">Facebook<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-388[]\" value=\"Jameda\" \/><span class=\"wpcf7-list-item-label\">Jameda<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-388[]\" value=\"Sonstiges\" \/><span class=\"wpcf7-list-item-label\">Sonstiges<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>Sonstige:<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-welche-empfehlung\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-welche-empfehlung\" \/><\/span>\n<\/p>\n<p><strong>Mit meiner Unterschrift best\u00e4tige ich Vollst\u00e4ndigkeit und Richtigkeit meiner umseitigen und obigen Angaben.<\/strong>\n<\/p>\n<p><label>Ort und Datum*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-ort-datum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-ort-datum\" \/><\/span>\n<\/p>\n<p>Unterschrift (Die Unterschrift erfolgt per Maus, Finger oder digitalem Stift)<br \/>\n<div class=\"wpcf7-form-control-signature-global-wrap\" data-field-id=\"unterschrift1\">\n\t\t\t\t<div class=\"wpcf7-form-control-signature-wrap\" style=\"width:400px;height:150px;\">\n\t\t\t\t\t<div class=\"wpcf7-form-control-signature-body\">\n\t\t\t\t\t\t<canvas id=\"wpcf7_unterschrift1_signature\" class=\"unterschrift1\"><\/canvas>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpcf7-form-control-clear-wrap\">\n\t\t\t\t\t<input id=\"wpcf7_unterschrift1_clear\" type=\"button\" value=\"Clear\"\/>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<span class=\"wpcf7-form-control-wrap wpcf7-form-control-signature-input-wrap unterschrift1\">\n\t\t\t\t<input class=\"wpcf7-form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"hidden\" name=\"unterschrift1\" id=\"wpcf7_input_unterschrift1\"\/><input type=\"hidden\" name=\"unterschrift1-attachment\" id=\"wpcf7_input_unterschrift1_attachment\"\/><input type=\"hidden\" name=\"unterschrift1-inline\" id=\"wpcf7_input_unterschrift1_inline\"\/>\n\t\t\t<\/span>\n\t\t\t\n<\/p>\n<h3>Informationen zum Datenschutz nach EU_DSGV\n<\/h3>\n<p><strong>Einverst\u00e4ndniserkl\u00e4rung des Kunden oder seines gesetzlichen Vertreters<\/strong>\n<\/p>\n<p>Ich stimme der Speicherung meiner pers\u00f6nlichen Daten I der pers\u00f6nlichen Daten meines Kindes ausdr\u00fccklich zu. Alle Angaben unterliegen nach \u00a7 203 StGB der \u00e4rztlichen Schweigepflicht- Diese werden f\u00fcr meine Behandlung und zur Kommunikation mit meinem Zahnarzt genutzt. Unser Unternehmen pr\u00fcft regelm\u00e4\u00dfig bei Vertragsabschl\u00fcssen und in bestimmten F\u00e4llen, in denen ein berechtigtes Interesse vorliegt, auch bei Bestandskunden, Ihre Bonit\u00e4t. Dazu arbeiten wir mit der Creditreform Boniversum GmbH, Hammfelddamm 13, 41460 Neuss zusammen, von der wir die dazu ben\u00f6tigten Daten erhalten. Zu diesem Zweck \u00fcbermitteln wir Ihren Namen und Ihre Kontaktdaten an die Creditreform Boniversum GmbH. Die Informationen gem. Art. 14 der EU-DSGVO zu der bei der Creditreform Boniversum GmbH stattfindenden Datenverarbeitung finden Sie hier: https:\/\/www.boniversum.de\/eu-dsgvo\/informationen-nach-eu-dsgvo-fuer-verbraucher<br \/>\n<br \/>\nDes Weiteren bin ich in Kenntnis gesetzt worden, dass ich das Recht habe, meiner Einwilligung jederzeit schriftlich zu widerrufen. Zudem erkl\u00e4re ich mich einverstanden, dass im Rahmen der kieferorthop\u00e4dischen Behandlung notwendige R\u00f6ntgenuntersuchungen bei meinem Kind gemacht werden.\n<\/p>\n<p><label>Ort und Datum*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textfeld-ort-datum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"textfeld-ort-datum\" \/><\/span>\n<\/p>\n<p>Unterschrift (Die Unterschrift erfolgt per Maus, Finger oder digitalem Stift)<br \/>\n<div class=\"wpcf7-form-control-signature-global-wrap\" data-field-id=\"unterschrift2\">\n\t\t\t\t<div class=\"wpcf7-form-control-signature-wrap\" style=\"width:400px;height:150px;\">\n\t\t\t\t\t<div class=\"wpcf7-form-control-signature-body\">\n\t\t\t\t\t\t<canvas id=\"wpcf7_unterschrift2_signature\" class=\"unterschrift2\"><\/canvas>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpcf7-form-control-clear-wrap\">\n\t\t\t\t\t<input id=\"wpcf7_unterschrift2_clear\" type=\"button\" value=\"Clear\"\/>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<span class=\"wpcf7-form-control-wrap wpcf7-form-control-signature-input-wrap unterschrift2\">\n\t\t\t\t<input class=\"wpcf7-form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"hidden\" name=\"unterschrift2\" id=\"wpcf7_input_unterschrift2\"\/><input type=\"hidden\" name=\"unterschrift2-attachment\" id=\"wpcf7_input_unterschrift2_attachment\"\/><input type=\"hidden\" name=\"unterschrift2-inline\" id=\"wpcf7_input_unterschrift2_inline\"\/>\n\t\t\t<\/span>\n\t\t\t\n<\/p>\n<p><strong>Hinweis:<\/strong>\n<\/p>\n<p>Die vereinbarten Termine sind ausschlie\u00dflich f\u00fcr Sie reserviert. Bitte vermeiden Sie kurzfristige Terminabsagen und -verschiebungen.Nicht wahrgenommenen Termine, die nicht sp\u00e4testens 24 Stunden zuvor abgesagt wurden und anderweitig vergeben werden konnten, berechnen wir - nach \u00a7\u00a7 615 [Regelungen des Dienstvertrages] und 280. Abs.1 [Verletzung vertraglicher Nebenleistungen] BGB - privat und stellen Ihnen den Honorarausfall in Rechnung. Wir sind berechtigt, diese auch Mitgliedern der gesetzlichen Krankenversicherung nach der Geb\u00fchrenordnung f\u00fcr Zahn\u00e4rzte (GOZ) in Rechnung zu stellen.\n<\/p>\n<p><strong>Als besonderen Service bieten wir Ihnen eine Erinnerung an Ihre Termine etwa 48 Stunden im Voraus.<\/strong><br \/>\n<strong>Hiermit stimme ich zu, dass mich mein Kieferorthop\u00e4de zu dem oben genannten Punkt auf folgendem Wege erinnern darf: <\/strong>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-389\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-389[]\" value=\"Ich w\u00fcnsche keine Terminerinnerung\" \/><span class=\"wpcf7-list-item-label\">Ich w\u00fcnsche keine Terminerinnerung<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-389[]\" value=\"Per SMS\" \/><span class=\"wpcf7-list-item-label\">Per SMS<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-389[]\" value=\"Per E-Mail\" \/><span class=\"wpcf7-list-item-label\">Per E-Mail<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><label>E-Mail f\u00fcr Terminerinnerung<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-terminerinnerung-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-terminerinnerung-email\" \/><\/span>\n<\/p>\n<p><label>Mobilnummer f\u00fcr SMS-Terminerinnerung<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-terminerinnerung-sms\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-terminerinnerung-sms\" \/><\/span>\n<\/p>\n<p><label>Ort und Datum*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"text-ort-datum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"text-ort-datum\" \/><\/span>\n<\/p>\n<p>Unterschrift (Die Unterschrift erfolgt per Maus, Finger oder digitalem Stift)<br \/>\n<div class=\"wpcf7-form-control-signature-global-wrap\" data-field-id=\"unterschrift3\">\n\t\t\t\t<div class=\"wpcf7-form-control-signature-wrap\" style=\"width:400px;height:150px;\">\n\t\t\t\t\t<div class=\"wpcf7-form-control-signature-body\">\n\t\t\t\t\t\t<canvas id=\"wpcf7_unterschrift3_signature\" class=\"unterschrift3\"><\/canvas>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"wpcf7-form-control-clear-wrap\">\n\t\t\t\t\t<input id=\"wpcf7_unterschrift3_clear\" type=\"button\" value=\"Clear\"\/>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<span class=\"wpcf7-form-control-wrap wpcf7-form-control-signature-input-wrap unterschrift3\">\n\t\t\t\t<input class=\"wpcf7-form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"hidden\" name=\"unterschrift3\" id=\"wpcf7_input_unterschrift3\"\/><input type=\"hidden\" name=\"unterschrift3-attachment\" id=\"wpcf7_input_unterschrift3_attachment\"\/><input type=\"hidden\" name=\"unterschrift3-inline\" id=\"wpcf7_input_unterschrift3_inline\"\/>\n\t\t\t<\/span>\n\t\t\t\n<\/p>\n<p style=\"color:red;\"><b>Alles ausgef\u00fcllt?<\/b> Dann dr\u00fccken Sie bitte jetzt auf \"Senden\"! Bitte warten Sie NACH dem Klick auf \"Senden\" einige Sekunden, bis die Daten vollst\u00e4ndig \u00fcbermittelt wurden, bevor Sie diese Seite verlassen.\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Senden\" \/><button type=\"button\" class=\"cf7mls_back action-button\" name=\"cf7mls_back\" id=\"cf7mls-back-btn-cf7mls_step-5\">Zur\u00fcck<\/button>\n<\/p><\/fieldset><\/div><input type=\"hidden\" id=\"ct_checkjs_cf7_69cb3ea317a32c4e6143e665fdb20b14\" name=\"ct_checkjs_cf7\" value=\"0\" \/><script>setTimeout(function(){var ct_input_name = \"ct_checkjs_cf7_69cb3ea317a32c4e6143e665fdb20b14\";if (document.getElementById(ct_input_name) !== null) {var ct_input_value = document.getElementById(ct_input_name).value;document.getElementById(ct_input_name).value = document.getElementById(ct_input_name).value.replace(ct_input_value, '1256480020');}}, 1000);<\/script><input\n                    class=\"apbct_special_field apbct_email_id__wp_contact_form_7\"\n                    name=\"apbct__email_id__wp_contact_form_7\"\n                    aria-label=\"apbct__label_id__wp_contact_form_7\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"94\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input\n                    class=\"apbct_special_field apbct_email_id__elementor_form\"\n                    name=\"apbct__email_id__elementor_form\"\n                    aria-label=\"apbct__label_id__elementor_form\"\n                    type=\"text\" size=\"30\" maxlength=\"200\" autocomplete=\"off\"\n                    value=\"\"\n                \/><\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-2258","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/doktorbabendererde.de\/ru\/wp-json\/wp\/v2\/pages\/2258","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/doktorbabendererde.de\/ru\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/doktorbabendererde.de\/ru\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/doktorbabendererde.de\/ru\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/doktorbabendererde.de\/ru\/wp-json\/wp\/v2\/comments?post=2258"}],"version-history":[{"count":31,"href":"https:\/\/doktorbabendererde.de\/ru\/wp-json\/wp\/v2\/pages\/2258\/revisions"}],"predecessor-version":[{"id":3177,"href":"https:\/\/doktorbabendererde.de\/ru\/wp-json\/wp\/v2\/pages\/2258\/revisions\/3177"}],"wp:attachment":[{"href":"https:\/\/doktorbabendererde.de\/ru\/wp-json\/wp\/v2\/media?parent=2258"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}