{"id":124,"date":"2025-12-17T15:39:22","date_gmt":"2025-12-17T15:39:22","guid":{"rendered":"https:\/\/lie.lievaart-vc.nl\/?page_id=124"},"modified":"2026-01-12T12:35:50","modified_gmt":"2026-01-12T12:35:50","slug":"inschrijven","status":"publish","type":"page","link":"https:\/\/www.tandartsenpraktijklie.nl\/?page_id=124","title":{"rendered":"Inschrijven"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;off|desktop&#8221; admin_label=&#8221;Header&#8221; _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; background_enable_color=&#8221;off&#8221; overflow-x=&#8221;hidden&#8221; overflow-y=&#8221;hidden&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; custom_padding_tablet=&#8221;||75px||false|false&#8221; custom_padding_phone=&#8221;||50px||false|false&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{%22gcid-4dccef5c-a04c-4e7c-abbe-b1e880c58010%22:%91%22background_color%22%93}&#8221;][et_pb_row column_structure=&#8221;1_2,1_2&#8243; module_id=&#8221;over-ons&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; z_index=&#8221;1&#8243; width=&#8221;90%&#8221; width_tablet=&#8221;90%&#8221; width_phone=&#8221;90%&#8221; width_last_edited=&#8221;on|phone&#8221; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;8%||||false|false&#8221; custom_padding_tablet=&#8221;12%||||false|false&#8221; custom_padding_phone=&#8221;12%||||false|false&#8221; custom_padding_last_edited=&#8221;on|desktop&#8221; custom_css_free_form=&#8221;selector .et_pb_button_module_wrapper {||  display: inline-block;||  margin-right: 12px;||}&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;5a1fa098-6b31-48bd-b151-bf768c02cb1c&#8221; header_2_text_color=&#8221;#545453&#8243; custom_margin=&#8221;||10px||false|false&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Inschrijven<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.19.5&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; admin_label=&#8221;Services&#8221; _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; background_enable_color=&#8221;off&#8221; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||100px||false|false&#8221; custom_padding_tablet=&#8221;0px||75px||false|false&#8221; custom_padding_phone=&#8221;0px||50px||false|false&#8221; saved_tabs=&#8221;all&#8221; locked=&#8221;off&#8221; collapsed=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row custom_padding_last_edited=&#8221;off|desktop&#8221; module_id=&#8221;maassluis&#8221; _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; width=&#8221;90%&#8221; width_tablet=&#8221;90%&#8221; width_phone=&#8221;90%&#8221; width_last_edited=&#8221;off|desktop&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; custom_padding_tablet=&#8221;75px||75px||false|false&#8221; custom_padding_phone=&#8221;0px||50px||false|false&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;25px|25px|25px|25px|true|true&#8221; custom_padding_tablet=&#8221;25px|25px|25px|25px|true|true&#8221; custom_padding_phone=&#8221;25px|25px|25px|25px|true|true&#8221; custom_padding_last_edited=&#8221;on|phone&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221; border_width_all=&#8221;1px&#8221; border_color_all=&#8221;#545453&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<div class=\"forminator-ui forminator-custom-form forminator-custom-form-827 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-827\" data-uid=\"69e5e14af355d\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-827\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-827 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"827\"\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69e5e14af355d\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">Op welke locatie wit u zich inschrijven?<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><select  id=\"forminator-form-827__field--select-2_69e5e14af355d\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies uw locatie\" data-search=\"false\" data-search-placeholder=\"Kies uw locatie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-827__field--select-2_69e5e14af355d-label\"><option value=\"\"  >Kies uw locatie<\/option><option value=\"one\"  data-calculation=\"0\">Maassluis<\/option><option value=\"two\"  data-calculation=\"0\">Maasland<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">Persoonlijke gegevens<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-4\"><div class=\"forminator-field\"><input type=\"text\" name=\"name-1-first-name\" placeholder=\"Voornaam\" id=\"forminator-field-first-name-1_69e5e14af355d\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-4\"><div class=\"forminator-field\"><input type=\"text\" name=\"name-1-middle-name\" placeholder=\"tussenv. (optioneel)\" id=\"forminator-field-middle-name-1_69e5e14af355d\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"additional-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-4\"><div class=\"forminator-field\"><input type=\"text\" name=\"name-1-last-name\" placeholder=\"Achternaam\" id=\"forminator-field-last-name-1_69e5e14af355d\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-8\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">Geboortedatum<\/label><div class=\"forminator-date-select\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><select name=\"date-1-day\" id=\"forminator-field-827__field--date-1-day_69e5e14af355d\" class=\"forminator-select2\" data-format=\"dd-mm-yy\" data-parent=\"date-1\" data-default-value=\"12\"><option value=\"\" >Selecteer dag<\/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\" selected=\"selected\">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><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><select name=\"date-1-month\" id=\"forminator-field-827__field--date-1-month_69e5e14af355d\" class=\"forminator-select2\" data-format=\"dd-mm-yy\" data-parent=\"date-1\" data-default-value=\"1\"><option value=\"\" >Selecteer maand<\/option><option value=\"1\" selected=\"selected\">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><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><select name=\"date-1-year\" id=\"forminator-field-827__field--date-1-year_69e5e14af355d\" class=\"forminator-select2\" data-format=\"dd-mm-yy\" data-parent=\"date-1\" data-default-value=\"2026\"><option value=\"\" >Selecteer jaar<\/option><option value=\"2026\" selected=\"selected\">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><\/select><\/div><\/div><\/div><\/div><\/div><div id=\"section-16\" class=\"forminator-field-section forminator-col forminator-col-4 \"><div class=\"forminator-field\"><\/div><\/div><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-827__field--select-1_69e5e14af355d\" id=\"forminator-form-827__field--select-1_69e5e14af355d-label\" class=\"forminator-label\">Geslacht<\/label><select  id=\"forminator-form-827__field--select-1_69e5e14af355d\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-827__field--select-1_69e5e14af355d-label\"><option value=\"one\"  data-calculation=\"0\">Man<\/option><option value=\"two\"  data-calculation=\"0\">Vrouw<\/option><option value=\"Anders\"  data-calculation=\"0\">Anders<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69e5e14af355d\" id=\"forminator-field-address-1-street_address_69e5e14af355d-label\" class=\"forminator-label\">Straatnaam + huisnummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Straatnaam + huisnummer\" id=\"forminator-field-address-1-street_address_69e5e14af355d\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69e5e14af355d\" id=\"forminator-field-address-1-city_69e5e14af355d-label\" class=\"forminator-label\">Plaatsnaam <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Plaatsnaam\" id=\"forminator-field-address-1-city_69e5e14af355d\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_69e5e14af355d\" id=\"forminator-field-address-1-zip_69e5e14af355d-label\" class=\"forminator-label\">Postcode <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Postcode\" id=\"forminator-field-address-1-zip_69e5e14af355d\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-15\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E-mailadres\" id=\"forminator-field-email-1_69e5e14af355d\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-14\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Telefoonnummer\" id=\"forminator-field-phone-1_69e5e14af355d\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-12\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">Administratieve gegevens<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69e5e14af355d\" id=\"forminator-field-text-1_69e5e14af355d-label\" class=\"forminator-label\">Verzekeringsmaatschappij <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"Verzekeringsmaatschappij\" id=\"forminator-field-text-1_69e5e14af355d\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69e5e14af355d\" id=\"forminator-field-text-2_69e5e14af355d-label\" class=\"forminator-label\">BSN Nummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"BSN Nummer\" id=\"forminator-field-text-2_69e5e14af355d\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69e5e14af355d\" id=\"forminator-field-text-3_69e5e14af355d-label\" class=\"forminator-label\">Verzekeringsnummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"Verzekeringsnummer\" id=\"forminator-field-text-3_69e5e14af355d\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-13\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69e5e14af355d\" id=\"forminator-field-textarea-1_69e5e14af355d-label\" class=\"forminator-label\">Bijzonderheden<\/label><textarea name=\"textarea-1\" placeholder=\"Vul hier eventuele bijzonderheden in\" id=\"forminator-field-textarea-1_69e5e14af355d\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Versturen<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"a93632910a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F124\" \/><input type=\"hidden\" name=\"form_id\" value=\"827\"><input type=\"hidden\" name=\"page_id\" value=\"124\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.tandartsenpraktijklie.nl\/?page_id=124\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Inschrijven<div class=\"forminator-ui forminator-custom-form forminator-custom-form-827 forminator-design--default  forminator_ajax\" data-forminator-render=\"1\" data-form=\"forminator-module-827\" data-uid=\"69e5e14b5123f\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-827\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-827 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"1\"\n\t\t\t\tdata-form-id=\"827\"\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69e5e14b5123f\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"section-6\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">Op welke locatie wit u zich inschrijven?<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"select-2\" class=\"forminator-field-select forminator-col forminator-col-12 \"><div class=\"forminator-field\"><select  id=\"forminator-form-827__field--select-2_69e5e14b5123f\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"1\" name=\"select-2\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"Kies uw locatie\" data-search=\"false\" data-search-placeholder=\"Kies uw locatie\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-827__field--select-2_69e5e14b5123f-label\"><option value=\"\"  >Kies uw locatie<\/option><option value=\"one\"  data-calculation=\"0\">Maassluis<\/option><option value=\"two\"  data-calculation=\"0\">Maasland<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-3\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">Persoonlijke gegevens<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12 \"><div class=\"forminator-row forminator-no-margin\" data-multiple=\"true\"><div class=\"forminator-col forminator-col-md-4\"><div class=\"forminator-field\"><input type=\"text\" name=\"name-1-first-name\" placeholder=\"Voornaam\" id=\"forminator-field-first-name-1_69e5e14b5123f\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"given-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-4\"><div class=\"forminator-field\"><input type=\"text\" name=\"name-1-middle-name\" placeholder=\"tussenv. (optioneel)\" id=\"forminator-field-middle-name-1_69e5e14b5123f\" class=\"forminator-input\" aria-required=\"false\" data-multi=\"1\" autocomplete=\"additional-name\" value=\"\" \/><\/div><\/div><div class=\"forminator-col forminator-col-md-4\"><div class=\"forminator-field\"><input type=\"text\" name=\"name-1-last-name\" placeholder=\"Achternaam\" id=\"forminator-field-last-name-1_69e5e14b5123f\" class=\"forminator-input\" aria-required=\"true\" data-multi=\"1\" autocomplete=\"family-name\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-8\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"date-1\" class=\"forminator-field-date forminator-col forminator-col-4 \"><label for=\"forminator-field-date-1\" id=\"forminator-field-date-1-label\" class=\"forminator-label\">Geboortedatum<\/label><div class=\"forminator-date-select\"><div class=\"forminator-row\" data-multiple=\"true\"><div id=\"date-1-day\" class=\"forminator-col\"><div class=\"forminator-field\"><select name=\"date-1-day\" id=\"forminator-field-827__field--date-1-day_69e5e14b5123f\" class=\"forminator-select2\" data-format=\"dd-mm-yy\" data-parent=\"date-1\" data-default-value=\"12\"><option value=\"\" >Selecteer dag<\/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\" selected=\"selected\">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><div id=\"date-1-month\" class=\"forminator-col\"><div class=\"forminator-field\"><select name=\"date-1-month\" id=\"forminator-field-827__field--date-1-month_69e5e14b5123f\" class=\"forminator-select2\" data-format=\"dd-mm-yy\" data-parent=\"date-1\" data-default-value=\"1\"><option value=\"\" >Selecteer maand<\/option><option value=\"1\" selected=\"selected\">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><div id=\"date-1-year\" class=\"forminator-col\"><div class=\"forminator-field\"><select name=\"date-1-year\" id=\"forminator-field-827__field--date-1-year_69e5e14b5123f\" class=\"forminator-select2\" data-format=\"dd-mm-yy\" data-parent=\"date-1\" data-default-value=\"2026\"><option value=\"\" >Selecteer jaar<\/option><option value=\"2026\" selected=\"selected\">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><\/select><\/div><\/div><\/div><\/div><\/div><div id=\"section-16\" class=\"forminator-field-section forminator-col forminator-col-4 \"><div class=\"forminator-field\"><\/div><\/div><div id=\"select-1\" class=\"forminator-field-select forminator-col forminator-col-4 \"><div class=\"forminator-field\"><label for=\"forminator-form-827__field--select-1_69e5e14b5123f\" id=\"forminator-form-827__field--select-1_69e5e14b5123f-label\" class=\"forminator-label\">Geslacht<\/label><select  id=\"forminator-form-827__field--select-1_69e5e14b5123f\" class=\"forminator-select--field forminator-select2 forminator-select2-multiple\" data-required=\"\" name=\"select-1\" data-default-value=\"\" data-hidden-behavior=\"zero\" data-placeholder=\"\" data-search=\"false\" data-search-placeholder=\"\" data-checkbox=\"false\" data-allow-clear=\"false\" aria-labelledby=\"forminator-form-827__field--select-1_69e5e14b5123f-label\"><option value=\"one\"  data-calculation=\"0\">Man<\/option><option value=\"two\"  data-calculation=\"0\">Vrouw<\/option><option value=\"Anders\"  data-calculation=\"0\">Anders<\/option><\/select><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-2\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"address-1\" class=\"forminator-field-address forminator-col forminator-col-12 \"><div class=\"forminator-row\"><div id=\"address-1-street_address\" class=\"forminator-col\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-street_address_69e5e14b5123f\" id=\"forminator-field-address-1-street_address_69e5e14b5123f-label\" class=\"forminator-label\">Straatnaam + huisnummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-street_address\" placeholder=\"Straatnaam + huisnummer\" id=\"forminator-field-address-1-street_address_69e5e14b5123f\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-line1\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-city\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-city_69e5e14b5123f\" id=\"forminator-field-address-1-city_69e5e14b5123f-label\" class=\"forminator-label\">Plaatsnaam <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-city\" placeholder=\"Plaatsnaam\" id=\"forminator-field-address-1-city_69e5e14b5123f\" class=\"forminator-input\" data-required=\"1\" aria-required=\"true\" autocomplete=\"address-level2\" value=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\" data-multiple=\"false\"><div id=\"address-1-zip\" class=\"forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-address-1-zip_69e5e14b5123f\" id=\"forminator-field-address-1-zip_69e5e14b5123f-label\" class=\"forminator-label\">Postcode <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"address-1-zip\" placeholder=\"Postcode\" id=\"forminator-field-address-1-zip_69e5e14b5123f\" class=\"forminator-input\" autocomplete=\"postal-code\" value=\"\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-15\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12 \"><div class=\"forminator-field\"><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E-mailadres\" id=\"forminator-field-email-1_69e5e14b5123f\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-14\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12 \"><div class=\"forminator-field\"><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"Telefoonnummer\" id=\"forminator-field-phone-1_69e5e14b5123f\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-12\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><h3 class=\"forminator-subtitle\">Administratieve gegevens<\/h3><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69e5e14b5123f\" id=\"forminator-field-text-1_69e5e14b5123f-label\" class=\"forminator-label\">Verzekeringsmaatschappij <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"Verzekeringsmaatschappij\" id=\"forminator-field-text-1_69e5e14b5123f\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69e5e14b5123f\" id=\"forminator-field-text-2_69e5e14b5123f-label\" class=\"forminator-label\">BSN Nummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"BSN Nummer\" id=\"forminator-field-text-2_69e5e14b5123f\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69e5e14b5123f\" id=\"forminator-field-text-3_69e5e14b5123f-label\" class=\"forminator-label\">Verzekeringsnummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"Verzekeringsnummer\" id=\"forminator-field-text-3_69e5e14b5123f\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"section-13\" class=\"forminator-field-section forminator-col forminator-col-12 \"><div class=\"forminator-field\"><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69e5e14b5123f\" id=\"forminator-field-textarea-1_69e5e14b5123f-label\" class=\"forminator-label\">Bijzonderheden<\/label><textarea name=\"textarea-1\" placeholder=\"Vul hier eventuele bijzonderheden in\" id=\"forminator-field-textarea-1_69e5e14b5123f\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">Versturen<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"a93632910a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F124\" \/><input type=\"hidden\" name=\"form_id\" value=\"827\"><input type=\"hidden\" name=\"page_id\" value=\"124\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.tandartsenpraktijklie.nl\/?page_id=124\"><input type=\"hidden\" name=\"render_id\" value=\"1\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-124","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.tandartsenpraktijklie.nl\/index.php?rest_route=\/wp\/v2\/pages\/124","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.tandartsenpraktijklie.nl\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.tandartsenpraktijklie.nl\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.tandartsenpraktijklie.nl\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tandartsenpraktijklie.nl\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=124"}],"version-history":[{"count":6,"href":"https:\/\/www.tandartsenpraktijklie.nl\/index.php?rest_route=\/wp\/v2\/pages\/124\/revisions"}],"predecessor-version":[{"id":834,"href":"https:\/\/www.tandartsenpraktijklie.nl\/index.php?rest_route=\/wp\/v2\/pages\/124\/revisions\/834"}],"wp:attachment":[{"href":"https:\/\/www.tandartsenpraktijklie.nl\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=124"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}