{"id":381,"date":"2014-04-14T16:53:48","date_gmt":"2014-04-14T16:53:48","guid":{"rendered":"http:\/\/bliccathemes.com\/medicom\/?page_id=381"},"modified":"2021-06-03T14:20:57","modified_gmt":"2021-06-03T12:20:57","slug":"praktijkinformatie","status":"publish","type":"page","link":"https:\/\/thcveur.nl\/?page_id=381","title":{"rendered":"Inschrijven"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row][vc_column][vc_column_text el_class=&#8221;titleBorder&#8221;]<\/p>\n<h2>BIJ ONS\u00a0<strong>AANMELDEN<\/strong><\/h2>\n<p>[\/vc_column_text][vc_column_text el_class=&#8221;bigP&#8221;]Via onderstaand formulier kunt u zich eenvoudig inschrijven als nieuwe pati\u00ebnt bij Tandheelkundig Centrum Veur.[\/vc_column_text][vc_row_inner][vc_column_inner width=&#8221;1\/2&#8243;][vc_single_image image=&#8221;3016&#8243; img_size=&#8221;460&#215;690&#8243; alignment=&#8221;center&#8221;][vc_separator][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1344-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"1344\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F381#wpcf7-f1344-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1344\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1344-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"container\">\n\t<div class=\"row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"FName\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required medicom-forms\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Voor- en Achternaam\" value=\"\" type=\"text\" name=\"FName\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Geboortedatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required medicom-forms\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Geboortedatum\" value=\"\" type=\"text\" name=\"Geboortedatum\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email-656\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email medicom-forms\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email\" value=\"\" type=\"email\" name=\"email-656\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel medicom-forms\" aria-invalid=\"false\" placeholder=\"Telefoonnummer\" value=\"\" type=\"tel\" name=\"Phone\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"BSNnummer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text medicom-forms\" aria-invalid=\"false\" placeholder=\"BSN nummer\" value=\"\" type=\"text\" name=\"BSNnummer\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Sex\"><select class=\"wpcf7-form-control wpcf7-select medicom-forms\" aria-invalid=\"false\" name=\"Sex\"><option value=\"Man\">Man<\/option><option value=\"Vrouw\">Vrouw<\/option><option value=\"Kind\">Kind<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"adres\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text medicom-forms\" aria-invalid=\"false\" placeholder=\"Adres\" value=\"\" type=\"text\" name=\"adres\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"FPost\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required medicom-forms\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Postcode\" value=\"\" type=\"text\" name=\"FPost\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-md-6\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Lwpls\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required medicom-forms\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Woonplaats\" value=\"\" type=\"text\" name=\"Lwpls\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea medicom-forms\" aria-invalid=\"false\" placeholder=\"Aanvullend bericht\" name=\"Message\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-834\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-834\" value=\"1\" checked=\"checked\" aria-invalid=\"false\" \/><\/span><\/span><\/span> Ik ga akkoord met de <a href=\"https:\/\/thcveur.nl\/wp-content\/uploads\/2016\/01\/praktijkregels.pdf\" target=\"_blank\">Praktijkvoorwaarden<\/a> en heb deze gelezen.\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"row\">\n\t\t<div class=\"col-md-12\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"privacypolicy\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"privacypolicy\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">Door dit formulier te gebruiken gaat u akkoord met de opslag en verwerking<br> van uw gegevens via deze website. <a class=\"link\"href=\"https:\/\/thcveur.nl\/privacy-policy\/\" target=\"_blank\"> Privacy Policy<\/a><\/span><\/label><\/span><\/span><\/span><br \/>\n<br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner buton b_asset buton-2 buton-mini\" type=\"submit\" value=\"Verzend\" \/>\n\t\t\t<\/p>\n\t\t\t<div class=\"row\">\n\t\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css_animation=&#8221;top-to-bottom&#8221; el_class=&#8221;bigP&#8221;]<\/p>\n<h1 style=\"text-align: center;\"><span style=\"color: #2b96cc;\"><strong>NA INSCHRIJVING<\/strong><\/span><\/h1>\n<p style=\"text-align: center;\">Wij nemen telefonisch contact met u op voor een eerste afspraak. Wilt u zich met meerdere gezinsleden inschrijven, geef dat dan even aan bij de opmerkingen in het inschrijfformulier. Wij nemen vervolgens contact met u op om alle gegevens te noteren.<\/p>\n<p>[\/vc_column_text][\/vc_column][\/vc_row][vc_row][vc_column][vc_separator color=&#8221;custom&#8221; accent_color=&#8221;#2b96cc&#8221;][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row][vc_column][vc_column_text el_class=&#8221;titleBorder&#8221;] BIJ ONS\u00a0AANMELDEN [\/vc_column_text][vc_column_text el_class=&#8221;bigP&#8221;]Via onderstaand formulier kunt u zich eenvoudig inschrijven als nieuwe pati\u00ebnt bij Tandheelkundig Centrum Veur.[\/vc_column_text][vc_row_inner][vc_column_inner width=&#8221;1\/2&#8243;][vc_single_image image=&#8221;3016&#8243; img_size=&#8221;460&#215;690&#8243; alignment=&#8221;center&#8221;][vc_separator][\/vc_column_inner][vc_column_inner width=&#8221;1\/2&#8243;][\/vc_column_inner][\/vc_row_inner][\/vc_column][\/vc_row][vc_row][vc_column][vc_column_text css_animation=&#8221;top-to-bottom&#8221; el_class=&#8221;bigP&#8221;] NA INSCHRIJVING Wij nemen telefonisch contact met u op voor een eerste afspraak. Wilt u zich met meerdere gezinsleden inschrijven, geef dat dan even aan bij de opmerkingen in het inschrijfformulier. Wij nemen vervolgens contact met u op om alle gegevens te noteren. 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