{"id":294,"date":"2017-09-29T14:18:39","date_gmt":"2017-09-29T14:18:39","guid":{"rendered":"http:\/\/kraamvda.nl\/?page_id=294"},"modified":"2017-09-29T14:19:25","modified_gmt":"2017-09-29T14:19:25","slug":"notification-form","status":"publish","type":"page","link":"https:\/\/kraamvda.nl\/en\/notification-form\/","title":{"rendered":"NOTIFICATION FORM"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f157-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"157\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/294#wpcf7-f157-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=\"157\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f157-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"wpcf7-turnstile cf-turnstile\" data-sitekey=\"0x4AAAAAAB6ey9pDbh9tNLnA\" data-response-field-name=\"_wpcf7_turnstile_response\"><\/div>\n\n<div class=\"formcontainer\">\n\t<p><b>Gegevens cli\u00ebnt<\/b><br \/>\n<span class=\"formlabel\">Cli\u00ebntnummer<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Clientnummer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Clientnummer\" \/><\/span><br \/>\n<span class=\"formlabel\">Voorletters<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Voorletters\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Voorletters\" \/><\/span><br \/>\n<span class=\"formlabel\">Tussenvoegsel<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Tussenvoegsel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Tussenvoegsel\" \/><\/span><br \/>\n<span class=\"formlabel\">Achternaam<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Achternaam\"><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=\"Achternaam\" \/><\/span><br \/>\n<span class=\"formlabel\">Straat<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Straat\"><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=\"Straat\" \/><\/span><br \/>\n<span class=\"formlabel\">Huisnummer<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Huisnummer\"><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=\"Huisnummer\" \/><\/span><br \/>\n<span class=\"formlabel\">Postcode<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Postcode\"><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=\"Postcode\" \/><\/span><br \/>\n<span class=\"formlabel\">Woonplaats<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Woonplaats\"><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=\"Woonplaats\" \/><\/span><br \/>\n<span class=\"formlabel\">Geslacht<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Geslacht\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Geslacht\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Geslacht\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/label><\/span><\/span><\/span><br \/>\n<span class=\"formlabel\">Geboortedatum<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Geboortedatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Geboortedatum\" \/><\/span><br \/>\n<span class=\"formlabel\">Telefoonnummer<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Telefoonnummer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-text wpcf7-validates-as-tel\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"Telefoonnummer\" \/><\/span><br \/>\n<span class=\"formlabel\">E-mail<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"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=\"E-mail\" \/><\/span>\n\t<\/p>\n\t<p><b>Gegevens klacht<\/b>\n\t<\/p>\n\t<p><span class=\"formlabel\">Datum \/ tijd voorval* (m.b.v. kalender de datum en tijd invullen)<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"datum-voorval\"><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=\"datum-voorval\" \/><\/span><br \/>\n<span class=\"formlabel\">Categorie<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Categorie\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Categorie\" value=\"bereikbaarheid\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">bereikbaarheid<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Categorie\" value=\"voorlichting en informatieverstrekking\" \/><span class=\"wpcf7-list-item-label\">voorlichting en informatieverstrekking<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Categorie\" value=\"medewerker\" \/><span class=\"wpcf7-list-item-label\">medewerker<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Categorie\" value=\"planning diensten en zorg\" \/><span class=\"wpcf7-list-item-label\">planning diensten en zorg<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"Categorie\" value=\"verleende zorg\" \/><span class=\"wpcf7-list-item-label\">verleende zorg<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Categorie\" value=\"factuur niet correct\" \/><span class=\"wpcf7-list-item-label\">factuur niet correct<\/span><\/label><\/span><\/span><\/span><br \/>\n<span class=\"formlabel\">Toelichting categorie:*<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Toelichting\"><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=\"Toelichting\" \/><\/span><br \/>\n<span class=\"formlabel formtop\">Omschrijving*<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Omschrijving\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Omschrijving\"><\/textarea><\/span><br \/>\n<span class=\"formlabel formtop\">Heeft u een verbetervoorstel?<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Verbetervoorstel\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"Verbetervoorstel\"><\/textarea><\/span>\n\t<\/p>\n\t<p><span id=\"wpcf7-69f533ce2cd3a-wrapper\" class=\"wpcf7-form-control-wrap referentieval-wrap\" ><input type=\"hidden\" name=\"referentieval-time-start\" value=\"1777677262\"><input type=\"hidden\" name=\"referentieval-time-check\" value=\"4\"><label for=\"wpcf7-69f533ce2cd3a-field\" class=\"hp-message\">Please leave this field empty.<\/label><input id=\"wpcf7-69f533ce2cd3a-field\"  class=\"wpcf7-form-control wpcf7-text\" type=\"text\" name=\"referentieval\" value=\"\" size=\"40\" tabindex=\"-1\" autocomplete=\"new-password\" \/><\/span>\n\t<\/p>\n\t<div class=\"submitcontainer\">\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Verstuur\" \/><img decoding=\"async\" class=\"arrow-informatie formarrow\" src=\"\/wp-content\/themes\/vdakraamzorg\/images\/arrow.png\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div><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=\"151\"\/><script>document.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );<\/script><\/p><div class=\"wpcf7-form-control-wrap maspik-field\">\n                <label for=\"full-name-maspik-hp\" class=\"wpcf7-form-control-label\">Leave this field empty<\/label>\n                <input size=\"1\" type=\"text\" autocomplete=\"off\" aria-hidden=\"true\" tabindex=\"-1\" aria-label=\"Leave this field empty\" name=\"full-name-maspik-hp\" id=\"full-name-maspik-hp\" class=\"wpcf7-form-control wpcf7-text\" placeholder=\"Leave this field empty\">\n            <\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","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-294","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/kraamvda.nl\/en\/wp-json\/wp\/v2\/pages\/294","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kraamvda.nl\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/kraamvda.nl\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/kraamvda.nl\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kraamvda.nl\/en\/wp-json\/wp\/v2\/comments?post=294"}],"version-history":[{"count":2,"href":"https:\/\/kraamvda.nl\/en\/wp-json\/wp\/v2\/pages\/294\/revisions"}],"predecessor-version":[{"id":298,"href":"https:\/\/kraamvda.nl\/en\/wp-json\/wp\/v2\/pages\/294\/revisions\/298"}],"wp:attachment":[{"href":"https:\/\/kraamvda.nl\/en\/wp-json\/wp\/v2\/media?parent=294"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}