{"id":545,"date":"2023-04-29T13:03:12","date_gmt":"2023-04-29T11:03:12","guid":{"rendered":"https:\/\/preview.dynaorth.de\/wp_HoriaTest\/?page_id=545"},"modified":"2024-01-08T22:25:09","modified_gmt":"2024-01-08T21:25:09","slug":"anmeldebogen-zum-erstgespraech","status":"publish","type":"page","link":"https:\/\/dr-saulean.de\/index.php\/anmeldebogen-zum-erstgespraech\/","title":{"rendered":"Anmeldebogen zum Erstgespr\u00e4ch"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8220;1&#8243; _builder_version=&#8220;4.21.0&#8243; _module_preset=&#8220;default&#8220; global_colors_info=&#8220;{}&#8220;][et_pb_row _builder_version=&#8220;4.21.0&#8243; _module_preset=&#8220;default&#8220; global_colors_info=&#8220;{}&#8220;][et_pb_column type=&#8220;4_4&#8243; _builder_version=&#8220;4.21.0&#8243; _module_preset=&#8220;default&#8220; global_colors_info=&#8220;{}&#8220;][et_pb_text _builder_version=&#8220;4.21.0&#8243; _module_preset=&#8220;default&#8220; global_colors_info=&#8220;{}&#8220;]<\/p>\n<h2 class=\"et_pb_contact_main_title\">Anmeldebogen zum Erstgespr\u00e4ch<\/h2>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8220;4.21.0&#8243; _module_preset=&#8220;default&#8220; global_colors_info=&#8220;{}&#8220;][et_pb_column type=&#8220;4_4&#8243; _builder_version=&#8220;4.21.0&#8243; _module_preset=&#8220;default&#8220; global_colors_info=&#8220;{}&#8220;][et_pb_code _builder_version=&#8220;4.23.4&#8243; _module_preset=&#8220;default&#8220; hover_enabled=&#8220;0&#8243; sticky_enabled=&#8220;0&#8243;]<div class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Kontaktformular Erstpatienten<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='545' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"854c3d13ac\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/545\" \/><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div data-type=\"name-element\" data-name=\"names_1\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_names_1_last_name_' id='label_ff_3_names_1_last_name_' >Name des Kindes \/ des Jugendlichen<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_3_names_1_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div data-type=\"name-element\" data-name=\"names_2\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_names_2_first_name_' id='label_ff_3_names_2_first_name_' >Vorname des Kindes \/ des Jugendlichen<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[first_name]\" id=\"ff_3_names_2_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_datetime' id='label_ff_3_datetime' aria-label=\"Geburtsdatum des Kindes \/ des Jugendlichen\">Geburtsdatum des Kindes \/ des Jugendlichen<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Geburtsdatum des Kindes \/ des Jugendlichen Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d.m.Y' type=\"text\" name=\"datetime\" id=\"ff_3_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text' id='label_ff_3_input_text' aria-label=\"Krankenkasse\">Krankenkasse<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_3_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_message' id='label_ff_3_message' aria-label=\"Bitte kurz die Problematik beschreiben\">Bitte kurz die Problematik beschreiben<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_3_message\" name=\"message\" id=\"ff_3_message\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"message\" ><\/textarea><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Hausarztvertrag AOK\">Hausarztvertrag AOK<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_023830c9f48c793c2b7a15861be05b14'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Ja\"  id='input_radio_023830c9f48c793c2b7a15861be05b14' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='input_radio_079e9fcb2e0060f662cf7d017c7947d6'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Nein\"  id='input_radio_079e9fcb2e0060f662cf7d017c7947d6' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Schultyp\">Schultyp<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_72803645c4ce292ffaffc0c3d71aed08'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Kindergarten\"  id='input_radio_1_72803645c4ce292ffaffc0c3d71aed08' aria-label='Kindergarten' aria-invalid='false' aria-required=true> <span>Kindergarten<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_e2e47fadeabf485e761ab64c26e07474'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Schule\"  id='input_radio_1_e2e47fadeabf485e761ab64c26e07474' aria-label='Schule' aria-invalid='false' aria-required=true> <span>Schule<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_dropdown' id='label_ff_3_dropdown' aria-label=\"Bezugsperson\">Bezugsperson<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_3_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_3_dropdown\"><option value=\"\">- Bitte ausw\u00e4hlen -<\/option><option value=\"Mutter\"  >Mutter<\/option><option value=\"Vater\"  >Vater<\/option><option value=\"Sonstige Bezugsperson\"  >Sonstige Bezugsperson<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_dropdown_1' id='label_ff_3_dropdown_1' aria-label=\"Verh\u00e4ltnis der Eltern\">Verh\u00e4ltnis der Eltern<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_3_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_3_dropdown_1\"><option value=\"\">- Bitte ausw\u00e4hlen -<\/option><option value=\"Zusammenlebend\"  >Zusammenlebend<\/option><option value=\"Getrennt\"  >Getrennt<\/option><option value=\"Geschieden\"  >Geschieden<\/option><\/select><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Geteiltes Sorgerecht?\">Geteiltes Sorgerecht?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_3bf49ce768fa45a39360abb3ded6f623'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Ja\"  id='input_radio_2_3bf49ce768fa45a39360abb3ded6f623' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='input_radio_2_3580ba0b12cec3d24005ea735fd6faec'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Nein\"  id='input_radio_2_3580ba0b12cec3d24005ea735fd6faec' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Falls JA: Liegt das Einverst\u00e4ndnis des anderen Elterteils vor?\">Falls JA: Liegt das Einverst\u00e4ndnis des anderen Elterteils vor?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_c9022eac2af21fd13cad191b8cc05271'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Ja\"  id='input_radio_3_c9022eac2af21fd13cad191b8cc05271' aria-label='Ja' aria-invalid='false' aria-required=false> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_a9a03ce12b2f7b743a0ed0048eb358b9'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Nein\"  id='input_radio_3_a9a03ce12b2f7b743a0ed0048eb358b9' aria-label='Nein' aria-invalid='false' 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name=\"email\" id=\"ff_3_email\" class=\"ff-el-form-control\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_8\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_1' id='label_ff_3_input_text_1' aria-label=\"Telefon\">Telefon<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_3_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_2' id='label_ff_3_input_text_2' aria-label=\"Mobiltelefon\">Mobiltelefon<\/label><\/div><div 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Weitere Informationen finden Sie in unseren <a href=\"https:\/\/dr-saulean.de\/index.php\/datenschutz-2#datenschutz_kontaktform\" target=\"_blank\" rel=\"noopener\">Datenschutzhinweisen.<\/a><\/p><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_943ed9da9fdcd327b43c5a7add91e424'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Ich habe die Datenschutzerkl\u00e4rung gelesen und stimme dieser zu\"  id='checkbox_943ed9da9fdcd327b43c5a7add91e424' aria-label='Ich habe die Datenschutzerkl\u00e4rung gelesen und stimme dieser zu' aria-invalid='false' aria-required=true> <span>Ich habe die Datenschutzerkl\u00e4rung gelesen und stimme dieser zu<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-text-center ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit 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class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_2 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_2\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Kontaktformular Erstpatienten<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='545' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"854c3d13ac\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/545\" \/><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div data-type=\"name-element\" data-name=\"names_1\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_names_1_last_name_' id='label_ff_3_2_names_1_last_name_' >Name des Kindes \/ des Jugendlichen<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_3_2_names_1_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div data-type=\"name-element\" data-name=\"names_2\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_names_2_first_name_' id='label_ff_3_2_names_2_first_name_' >Vorname des Kindes \/ des Jugendlichen<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[first_name]\" id=\"ff_3_2_names_2_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_datetime' id='label_ff_3_2_datetime' aria-label=\"Geburtsdatum des Kindes \/ des Jugendlichen\">Geburtsdatum des Kindes \/ des Jugendlichen<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Geburtsdatum des Kindes \/ des Jugendlichen Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d.m.Y' type=\"text\" name=\"datetime\" id=\"ff_3_2_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_input_text' id='label_ff_3_2_input_text' aria-label=\"Krankenkasse\">Krankenkasse<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_3_2_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_message' id='label_ff_3_2_message' aria-label=\"Bitte kurz die Problematik beschreiben\">Bitte kurz die Problematik beschreiben<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_3_2_message\" name=\"message\" id=\"ff_3_2_message\" class=\"ff-el-form-control\" rows=\"4\" cols=\"2\" data-name=\"message\" ><\/textarea><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Hausarztvertrag AOK\">Hausarztvertrag AOK<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_f99e894fb51d3841b58ba38030ebd65a'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Ja\"  id='input_radio_f99e894fb51d3841b58ba38030ebd65a' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='input_radio_0733f141076e670678220467905ca7cb'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Nein\"  id='input_radio_0733f141076e670678220467905ca7cb' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Schultyp\">Schultyp<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_a75fb2e4834ae9f665fe245a6078c19c'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Kindergarten\"  id='input_radio_1_a75fb2e4834ae9f665fe245a6078c19c' aria-label='Kindergarten' aria-invalid='false' aria-required=true> <span>Kindergarten<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_71c00269f04ed44ee204ba6749fa4be1'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Schule\"  id='input_radio_1_71c00269f04ed44ee204ba6749fa4be1' aria-label='Schule' aria-invalid='false' aria-required=true> <span>Schule<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_dropdown' id='label_ff_3_2_dropdown' aria-label=\"Bezugsperson\">Bezugsperson<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_3_2_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_3_2_dropdown\"><option value=\"\">- Bitte ausw\u00e4hlen -<\/option><option value=\"Mutter\"  >Mutter<\/option><option value=\"Vater\"  >Vater<\/option><option value=\"Sonstige Bezugsperson\"  >Sonstige Bezugsperson<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_dropdown_1' id='label_ff_3_2_dropdown_1' aria-label=\"Verh\u00e4ltnis der Eltern\">Verh\u00e4ltnis der Eltern<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_3_2_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_3_2_dropdown_1\"><option value=\"\">- Bitte ausw\u00e4hlen -<\/option><option value=\"Zusammenlebend\"  >Zusammenlebend<\/option><option value=\"Getrennt\"  >Getrennt<\/option><option value=\"Geschieden\"  >Geschieden<\/option><\/select><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Geteiltes Sorgerecht?\">Geteiltes Sorgerecht?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_2_e346069f9175f8be3c6533b59c3191f8'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Ja\"  id='input_radio_2_e346069f9175f8be3c6533b59c3191f8' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check- ff_item_selected'><label class='ff-el-form-check-label' for='input_radio_2_2a7663dce92ab3e5d27cb8f54fb807c9'><input  type=\"radio\" name=\"input_radio_2\" data-name=\"input_radio_2\" class=\"ff-el-form-check-input ff-el-form-check-radio\" checked=\"1\" value=\"Nein\"  id='input_radio_2_2a7663dce92ab3e5d27cb8f54fb807c9' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Falls JA: Liegt das Einverst\u00e4ndnis des anderen Elterteils vor?\">Falls JA: Liegt das Einverst\u00e4ndnis des anderen Elterteils vor?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_89070eb75a9868b6b955954b89c4fcbe'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Ja\"  id='input_radio_3_89070eb75a9868b6b955954b89c4fcbe' aria-label='Ja' aria-invalid='false' aria-required=false> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_dd7bee75ca111aa4494e9c6b0337534f'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Nein\"  id='input_radio_3_dd7bee75ca111aa4494e9c6b0337534f' aria-label='Nein' aria-invalid='false' aria-required=false> <span>Nein<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_1 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_description_1' id='label_ff_3_2_description_1' aria-label=\"Anschrift (Erziehungsberechtigter)\">Anschrift (Erziehungsberechtigter)<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_3_2_description_1\" name=\"description_1\" id=\"ff_3_2_description_1\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_1\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_email' id='label_ff_3_2_email' aria-label=\"Email\">Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_3_2_email\" class=\"ff-el-form-control\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_8\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_2_input_text_1' id='label_ff_3_2_input_text_1' aria-label=\"Telefon\">Telefon<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_3_2_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_2_input_text_2' id='label_ff_3_2_input_text_2' aria-label=\"Mobiltelefon\">Mobiltelefon<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_3_2_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_1\" ><p>Wir verwenden Ihre Angaben zur Beantwortung Ihrer Anfrage. Weitere Informationen finden Sie in unseren <a href=\"https:\/\/dr-saulean.de\/index.php\/datenschutz-2#datenschutz_kontaktform\" target=\"_blank\" rel=\"noopener\">Datenschutzhinweisen.<\/a><\/p><\/div><div class='ff-el-group'><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_575866dfb80c2e99636a3e060211961b'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Ich habe die Datenschutzerkl\u00e4rung gelesen und stimme dieser zu\"  id='checkbox_575866dfb80c2e99636a3e060211961b' aria-label='Ich habe die Datenschutzerkl\u00e4rung gelesen und stimme dieser zu' aria-invalid='false' aria-required=true> <span>Ich habe die Datenschutzerkl\u00e4rung gelesen und stimme dieser zu<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group ff-text-center ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit 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