{"id":134,"date":"2023-03-22T14:38:15","date_gmt":"2023-03-22T14:38:15","guid":{"rendered":"http:\/\/lieslucassen.nl\/?page_id=134"},"modified":"2023-03-22T14:58:54","modified_gmt":"2023-03-22T14:58:54","slug":"aanmelden","status":"publish","type":"page","link":"http:\/\/lieslucassen.nl\/index.php\/aanmelden\/","title":{"rendered":"Aanmeldformulier"},"content":{"rendered":"<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-131\"><form id=\"wpforms-form-131\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"131\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/134\" data-token=\"28869a047ced684ebe2de4dc8eb187ca\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-131-field_1-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"1\"><label 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depth-1\"><input type=\"radio\" id=\"wpforms-131-field_2_1\" name=\"wpforms[fields][2]\" value=\"Jongen\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-131-field_2_1\">Jongen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-131-field_2_2\" name=\"wpforms[fields][2]\" value=\"Meisje\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-131-field_2_2\">Meisje<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-131-field_2_4\" name=\"wpforms[fields][2]\" value=\"Overig\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-131-field_2_4\">Overig<\/label><\/li><\/ul><\/div><div id=\"wpforms-131-field_3-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-131-field_3\">Geboortedatum kind <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-131-field_3\" 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id=\"wpforms-131-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" required><\/div><div id=\"wpforms-131-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-131-field_9\">Naam huisarts\/specialist <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-131-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" required><\/div><div id=\"wpforms-131-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-131-field_10\">Plaatsnaam huisarts\/specialist<\/label><input type=\"text\" id=\"wpforms-131-field_10\" class=\"wpforms-field-medium\" name=\"wpforms[fields][10]\" ><\/div><div id=\"wpforms-131-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-131-field_11\">Naam zorgverzekeraar: <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-131-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" required><\/div><div id=\"wpforms-131-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-131-field_12\">Verzekerdennummer zorgverzekeraar <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-131-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required><\/div><div id=\"wpforms-131-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-131-field_14\">Reden van aanmelding <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-131-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" required><\/textarea><div class=\"wpforms-field-description\">Omschrijf in dit veld waarom u uw kind aanmeldt bij Ergotherapie Lies Lucassen<\/div><\/div><div id=\"wpforms-131-field_15-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-131-field_15\">Al betrokken zorgverleners\/instanties\/school<\/label><textarea id=\"wpforms-131-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" ><\/textarea><div class=\"wpforms-field-description\">Zijn er al andere zorgverleners betrokken of krijgt uw kind al begeleiding op school? Omschrijf dat hier kort.<\/div><\/div><div id=\"wpforms-131-field_17-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-131-field_17\">Ik ga akkoord met de opslag van deze gegevens, de algemene voorwaarden en de behandelovereenkomst  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-131-field_17\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-131-field_17_1\" name=\"wpforms[fields][17][]\" value=\"Ja, ik ga akkoord\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-131-field_17_1\">Ja, ik ga akkoord<\/label><\/li><\/ul><div class=\"wpforms-field-description\">U vindt de algemene voorwaarden en de behandelovereenkomst onder het kopje 'werkwijze en vergoeding' op de website.\r\n<br><br>\r\nErgotherapie Lies Lucassen biedt DTE, direct toegankelijke ergotherapie, waardoor een verwijzing door een arts geen vereiste is.<\/div><\/div><\/div><div class=\"wpforms-submit-container\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"131\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-131\" class=\"wpforms-submit\" data-alt-text=\"Verzenden...\" data-submit-text=\"Verzend\" aria-live=\"assertive\" value=\"wpforms-submit\">Verzend<\/button><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/lieslucassen.nl\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-134","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"http:\/\/lieslucassen.nl\/index.php\/wp-json\/wp\/v2\/pages\/134","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/lieslucassen.nl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/lieslucassen.nl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/lieslucassen.nl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/lieslucassen.nl\/index.php\/wp-json\/wp\/v2\/comments?post=134"}],"version-history":[{"count":2,"href":"http:\/\/lieslucassen.nl\/index.php\/wp-json\/wp\/v2\/pages\/134\/revisions"}],"predecessor-version":[{"id":140,"href":"http:\/\/lieslucassen.nl\/index.php\/wp-json\/wp\/v2\/pages\/134\/revisions\/140"}],"wp:attachment":[{"href":"http:\/\/lieslucassen.nl\/index.php\/wp-json\/wp\/v2\/media?parent=134"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}