{"id":17764,"date":"2025-04-09T16:02:21","date_gmt":"2025-04-09T14:02:21","guid":{"rendered":"https:\/\/gezonde-darmflora.nl\/spender-werden\/"},"modified":"2025-05-08T17:10:52","modified_gmt":"2025-05-08T15:10:52","slug":"spender-werden","status":"publish","type":"page","link":"https:\/\/gezonde-darmflora.nl\/de\/spender-werden\/","title":{"rendered":"Spender werden"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row full_width=&#8220;stretch_row_content_no_spaces&#8220;][vc_column]\r\n    <div class=\"page-title\">\r\n        <div class=\"container\">\r\n            <div class=\"row\">\r\n                <div class=\"col\">\r\n                    <h1>Spender werden<\/h1>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n\r\n    [\/vc_column][\/vc_row][vc_row][vc_column]<style id=\"wpforms-css-vars-17753\">\n\t\t\t\t#wpforms-17753 {\n\t\t\t\t\n\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-17753\"><form id=\"wpforms-form-17753\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"17753\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/de\/wp-json\/wp\/v2\/pages\/17764\" data-token=\"9ecffa4dc18100b05253b2dc044268d9\" data-token-time=\"1775744799\"><noscript class=\"wpforms-error-noscript\">Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen.<\/div><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#066aab\" data-scroll=\"1\" role=\"progressbar\" aria-valuenow=\"1\" aria-valuemin=\"1\" aria-valuemax=\"12\" tabindex=\"-1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Schritt <span class=\"wpforms-page-indicator-steps-current\">1<\/span> von 12<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:8.3333333333333%;background-color:#066aab\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-17753-field_1-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"1\"><div id=\"wpforms-17753-field_1\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_1-error\"><h4>Pers\u00f6nliche Daten<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_152-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"152\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-17753-field_152\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][152][first]\" aria-errormessage=\"wpforms-17753-field_152-error\" required><label for=\"wpforms-17753-field_152\" class=\"wpforms-field-sublabel after\">Vorname<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-17753-field_152-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][152][last]\" aria-errormessage=\"wpforms-17753-field_152-last-error\" required><label for=\"wpforms-17753-field_152-last\" class=\"wpforms-field-sublabel after\">Nachname<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-17753-field_2-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_2\">Datum der Geburt <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17753-field_2\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][2][date]\" aria-errormessage=\"wpforms-17753-field_2-error\" required><a title=\"Datum leeren\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Datum leeren\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17753-field_153-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"153\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_153\">E-mail <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-17753-field_153\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][153]\" spellcheck=\"false\" aria-errormessage=\"wpforms-17753-field_153-error\" required><\/div><div id=\"wpforms-17753-field_4-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_4\">Mobiltelefon <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" aria-errormessage=\"wpforms-17753-field_4-error\" required><\/div><div id=\"wpforms-17753-field_154-container\" class=\"wpforms-field wpforms-field-address\" data-field-id=\"154\"><fieldset><legend class=\"wpforms-field-label\">Adresse<\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-17753-field_154\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][154][address1]\" aria-errormessage=\"wpforms-17753-field_154-error\" ><label for=\"wpforms-17753-field_154\" class=\"wpforms-field-sublabel after\">Adresse Zeile 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-17753-field_154-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][154][city]\" aria-errormessage=\"wpforms-17753-field_154-city-error\" ><label for=\"wpforms-17753-field_154-city\" class=\"wpforms-field-sublabel after\">Stadt<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-17753-field_154-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][154][state]\" aria-errormessage=\"wpforms-17753-field_154-state-error\" ><label for=\"wpforms-17753-field_154-state\" class=\"wpforms-field-sublabel after\">Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-17753-field_154-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][154][postal]\" aria-errormessage=\"wpforms-17753-field_154-postal-error\" ><label for=\"wpforms-17753-field_154-postal\" class=\"wpforms-field-sublabel after\">Postleitzahl<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-17753-field_154-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][154][country]\" aria-errormessage=\"wpforms-17753-field_154-country-error\" ><option class=\"placeholder\" value=\"\" selected disabled>--- W\u00e4hle country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albanien<\/option><option value=\"DZ\" >Algerien<\/option><option value=\"AS\" >Amerikanisch-Samoa<\/option><option value=\"VI\" >Amerikanische Jungferninseln<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarktika<\/option><option value=\"AG\" >Antigua und Barbuda<\/option><option value=\"AR\" >Argentinien<\/option><option value=\"AM\" >Armenien<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AZ\" >Aserbaidschan<\/option><option value=\"AU\" >Australien<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesch<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgien<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivien (Plurinationaler Staat)<\/option><option value=\"BQ\" >Bonaire, Sint Eustatius und Saba<\/option><option value=\"BA\" >Bosnien und Herzegowina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvetinsel<\/option><option value=\"BR\" >Brasilien<\/option><option value=\"VG\" >Britische Jungferninseln<\/option><option value=\"IO\" >Britisches Territorium im Indischen Ozean<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgarien<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CK\" >Cookinseln<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"DE\" >Deutschland<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominikanische Republik<\/option><option value=\"DJ\" >Dschibuti<\/option><option value=\"DK\" >D\u00e4nemark<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"CI\" >Elfenbeink\u00fcste<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estland<\/option><option value=\"SZ\" >Eswatini (K\u00f6nigreich)<\/option><option value=\"FK\" >Falklandinseln (Malwinen)<\/option><option value=\"FJ\" >Fidschi<\/option><option value=\"FI\" >Finnland<\/option><option value=\"FR\" >Frankreich<\/option><option value=\"GF\" >Franz\u00f6sisch-Guayana<\/option><option value=\"PF\" >Franz\u00f6sisch-Polynesien<\/option><option value=\"TF\" >Franz\u00f6sische S\u00fcd- und Antarktisgebiete<\/option><option value=\"FO\" >F\u00e4r\u00f6er<\/option><option value=\"GA\" >Gabun<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GR\" >Griechenland<\/option><option value=\"GL\" >Gr\u00f6nland<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard und McDonaldinseln<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hongkong<\/option><option value=\"IN\" >Indien<\/option><option value=\"ID\" >Indonesien<\/option><option value=\"IQ\" >Irak<\/option><option value=\"IR\" >Iran (Islamische Republik)<\/option><option value=\"IE\" >Irland<\/option><option value=\"IS\" >Island<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italien<\/option><option value=\"JM\" >Jamaika<\/option><option value=\"JP\" >Japan<\/option><option value=\"YE\" >Jemen<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordanien<\/option><option value=\"KY\" >Kaimaninseln<\/option><option value=\"KH\" >Kambodscha<\/option><option value=\"CM\" >Kamerun<\/option><option value=\"CA\" >Kanada<\/option><option value=\"KZ\" >Kasachstan<\/option><option value=\"QA\" >Katar<\/option><option value=\"KE\" >Kenia<\/option><option value=\"KG\" >Kirgisistan<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"CC\" >Kokosinseln (Keelinginseln)<\/option><option value=\"CO\" >Kolumbien<\/option><option value=\"KM\" >Komoren<\/option><option value=\"CD\" >Kongo (Demokratische Republik)<\/option><option value=\"CG\" >Kongo (Republik)<\/option><option value=\"KP\" >Korea (Demokratische Volksrepublik)<\/option><option value=\"KR\" >Korea (Republik)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"HR\" >Kroatien<\/option><option value=\"CU\" >Kuba<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"LA\" >Laos (Demokratische Volksrepublik)<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettland<\/option><option value=\"LB\" >Libanon<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libyen<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Litauen<\/option><option value=\"LU\" >Luxemburg<\/option><option value=\"MO\" >Macau<\/option><option value=\"MG\" >Madagaskar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Malediven<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MA\" >Marokko<\/option><option value=\"MH\" >Marshallinseln<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauretanien<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexiko<\/option><option value=\"FM\" >Mikronesien<\/option><option value=\"MD\" >Moldau (Republik)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolei<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MZ\" >Mosambik<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NC\" >Neukaledonien<\/option><option value=\"NZ\" >Neuseeland<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NL\" >Niederlande<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"MK\" >Nordmazedonien (Republik)<\/option><option value=\"NF\" >Norfolkinsel<\/option><option value=\"NO\" >Norwegen<\/option><option value=\"MP\" >N\u00f6rdliche Marianen<\/option><option value=\"OM\" >Oman<\/option><option value=\"TL\" >Osttimor<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Pal\u00e4stina (Staat)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua-Neuguinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippinen<\/option><option value=\"PN\" >Pitcairninseln<\/option><option value=\"PL\" >Polen<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"RW\" >Ruanda<\/option><option value=\"RO\" >Rum\u00e4nien<\/option><option value=\"RU\" >Russland<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint-Barth\u00e9lemy<\/option><option value=\"PM\" >Saint-Pierre und Miquelon<\/option><option value=\"SB\" >Salomonen<\/option><option value=\"ZM\" >Sambia<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"SA\" >Saudi-Arabien<\/option><option value=\"SE\" >Schweden<\/option><option value=\"CH\" >Schweiz<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbien<\/option><option value=\"SC\" >Seychellen<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"ZW\" >Simbabwe<\/option><option value=\"SG\" >Singapur<\/option><option value=\"SX\" >Sint Maarten<\/option><option value=\"SK\" >Slowakei<\/option><option value=\"SI\" >Slowenien<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ES\" >Spanien<\/option><option value=\"SJ\" >Spitzbergen und Jan Mayen<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SH\" >St. Helena, Ascension und Tristan da Cunha<\/option><option value=\"KN\" >St. Kitts und Nevis<\/option><option value=\"LC\" >St. Lucia<\/option><option value=\"MF\" >St. Martin (franz\u00f6sisch)<\/option><option value=\"VC\" >St. Vincent und die Grenadinen<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Surinam<\/option><option value=\"SY\" >Syrien (Arabische Republik)<\/option><option value=\"ST\" >S\u00e3o Tom\u00e9 und Pr\u00edncipe<\/option><option value=\"ZA\" >S\u00fcdafrika<\/option><option value=\"GS\" >S\u00fcdgeorgien und die S\u00fcdlichen Sandwichinseln<\/option><option value=\"SS\" >S\u00fcdsudan<\/option><option value=\"TJ\" >Tadschikistan<\/option><option value=\"TW\" >Taiwan, Republik China<\/option><option value=\"TZ\" >Tansania (Vereinigte Republik)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad und Tobago<\/option><option value=\"TD\" >Tschad<\/option><option value=\"CZ\" >Tschechien<\/option><option value=\"TN\" >Tunesien<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks- und Caicosinseln<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkei<\/option><option value=\"US\" >USA<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"HU\" >Ungarn<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Usbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatikanstadt (Staat)<\/option><option value=\"VE\" >Venezuela (Bolivarische Republik)<\/option><option value=\"AE\" >Vereinigte Arabische Emirate<\/option><option value=\"GB\" >Vereinigtes K\u00f6nigreich von Gro\u00dfbritannien und Nordirland<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis und Futuna<\/option><option value=\"CX\" >Weihnachtsinsel<\/option><option value=\"EH\" >Westsahara<\/option><option value=\"CF\" >Zentralafrikanische Republik<\/option><option value=\"CY\" >Zypern<\/option><option value=\"EG\" >\u00c4gypten<\/option><option value=\"GQ\" >\u00c4quatorialguinea<\/option><option value=\"ET\" >\u00c4thiopien<\/option><option value=\"AX\" >\u00c5landinseln<\/option><option value=\"AT\" >\u00d6sterreich<\/option><\/select><label for=\"wpforms-17753-field_154-country\" class=\"wpforms-field-sublabel after\">Land<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-17753-field_6-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"6\"><fieldset><legend class=\"wpforms-field-label\">Geschlecht <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_6\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_6_1\" name=\"wpforms[fields][6]\" value=\"Mann\" aria-errormessage=\"wpforms-17753-field_6_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_6_1\">Mann<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_6_2\" name=\"wpforms[fields][6]\" value=\"Frau\" aria-errormessage=\"wpforms-17753-field_6_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_6_2\">Frau<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_7-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"7\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"1\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-17753-field_8-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"8\"><\/div><div id=\"wpforms-17753-field_10-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"10\"><div id=\"wpforms-17753-field_10\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_10-error\"><h4>K\u00f6rperdaten und allgemeine Gesundheit<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_11-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_11\">Wie hoch ist Ihr Gewicht? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_11\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-17753-field_11-error\" aria-describedby=\"wpforms-17753-field_11-description\" required><div id=\"wpforms-17753-field_11-description\" class=\"wpforms-field-description\">In kilo<\/div><\/div><div id=\"wpforms-17753-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_12\">Wie gro\u00df sind Sie? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-17753-field_12-error\" aria-describedby=\"wpforms-17753-field_12-description\" required><div id=\"wpforms-17753-field_12-description\" class=\"wpforms-field-description\">In CM<\/div><\/div><div id=\"wpforms-17753-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_13\">Wie hoch ist Ihr BMI? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_13\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-17753-field_13-error\" aria-describedby=\"wpforms-17753-field_13-description\" required><div id=\"wpforms-17753-field_13-description\" class=\"wpforms-field-description\">In cm\/kg2<\/div><\/div><div id=\"wpforms-17753-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_14\">Was ist Ihr Beruf\/Studium? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-17753-field_14-error\" required><\/div><div id=\"wpforms-17753-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_15\">Wie hoch ist Ihr Bildungsniveau? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-17753-field_15-error\" required><\/div><div id=\"wpforms-17753-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_16\">Wie ist Ihre Familie zusammengesetzt? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_16\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-17753-field_16-error\" required><\/div><div id=\"wpforms-17753-field_17-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"17\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"2\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"2\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-17753-field_18-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"18\"><div id=\"wpforms-17753-field_18\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_18-error\"><h4>Anamnese<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_19-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Wurden Sie auf nat\u00fcrlichem Wege oder per Kaiserschnitt geboren? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_19_1\" name=\"wpforms[fields][19]\" value=\"Nat\u00fcrlich\" aria-errormessage=\"wpforms-17753-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_19_1\">Nat\u00fcrlich<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_19_2\" name=\"wpforms[fields][19]\" value=\"Kaiserschnitt\" aria-errormessage=\"wpforms-17753-field_19_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_19_2\">Kaiserschnitt<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_20-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie Kinder?       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_20_1\" name=\"wpforms[fields][20]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_20_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_20_2\" name=\"wpforms[fields][20]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_20_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_22-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Wurden Sie jemals bei einer Untersuchung (als Spender oder anderweitig) abgelehnt?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_22_1\" name=\"wpforms[fields][22]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_22_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_22_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_22_2\" name=\"wpforms[fields][22]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_22_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_22_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_23-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"23\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_23\">Warum <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-17753-field_23\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][23]\" aria-errormessage=\"wpforms-17753-field_23-error\" required><\/textarea><\/div><div id=\"wpforms-17753-field_24-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie schon einmal Blut gespendet?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_24_1\" name=\"wpforms[fields][24]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_24_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_24_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_24_2\" name=\"wpforms[fields][24]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_24_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_24_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_27-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"27\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_27\">Wenn ja, wann war das letzte Mal? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17753-field_27\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][27][date]\" aria-errormessage=\"wpforms-17753-field_27-error\" required><a title=\"Datum leeren\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Datum leeren\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17753-field_28-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Waren Sie schon einmal bei einem Spezialisten (Arzt im Krankenhaus)?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_28_1\" name=\"wpforms[fields][28]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_28_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_28_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_28_2\" name=\"wpforms[fields][28]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_28_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_28_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_29-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_29\">Wann? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17753-field_29\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][29][date]\" aria-errormessage=\"wpforms-17753-field_29-error\" required><a title=\"Datum leeren\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Datum leeren\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17753-field_30-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"30\"><fieldset><legend class=\"wpforms-field-label\">Sind Sie gegen Covid-19 geimpft? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_30\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_30_1\" name=\"wpforms[fields][30]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_30_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_30_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_30_2\" name=\"wpforms[fields][30]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_30_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_30_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_31-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"31\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_31\">Wie viele Male? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17753-field_31\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][31]\" step=\"any\" aria-errormessage=\"wpforms-17753-field_31-error\" required><\/div><div id=\"wpforms-17753-field_32-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"32\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_32\">Welcher Hersteller? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_32\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][32]\" aria-errormessage=\"wpforms-17753-field_32-error\" required><\/div><div id=\"wpforms-17753-field_33-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"33\"><fieldset><legend class=\"wpforms-field-label\">Nehmen Sie Medikamente ein?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_33\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_33_1\" name=\"wpforms[fields][33]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_33_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_33_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_33_2\" name=\"wpforms[fields][33]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_33_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_33_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_34-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"34\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_34\">Wenn ja, welche Medikamente haben Sie erhalten? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_34\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-17753-field_34-error\" required><\/div><div id=\"wpforms-17753-field_35-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"35\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_35\">In welchem Jahr wurde diese Behandlung begonnen?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_35\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-17753-field_35-error\" required><\/div><div id=\"wpforms-17753-field_36-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"36\"><fieldset><legend class=\"wpforms-field-label\">Waren Sie in der Vergangenheit schon einmal depressiv?        <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_36\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_36_1\" name=\"wpforms[fields][36]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_36_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_36_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_36_2\" name=\"wpforms[fields][36]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_36_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_36_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_37-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"37\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_37\">Wann begann dies und wie lange dauerte es?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_37\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][37]\" aria-errormessage=\"wpforms-17753-field_37-error\" required><\/div><div id=\"wpforms-17753-field_38-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"38\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_38\">Haben Sie Medikamente dagegen eingenommen?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_38\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-17753-field_38-error\" required><\/div><div id=\"wpforms-17753-field_39-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"39\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"3\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"3\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-17753-field_40-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"40\"><div id=\"wpforms-17753-field_40\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_40-error\"><h4>Chronische Erkrankungen und Vererbung<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_41-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"41\"><fieldset><legend class=\"wpforms-field-label\">Wurden Sie wegen Autismus behandelt?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_41\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_41_1\" name=\"wpforms[fields][41]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_41_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_41_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_41_2\" name=\"wpforms[fields][41]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_41_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_41_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_42-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"42\"><fieldset><legend class=\"wpforms-field-label\">Wurden Sie jemals auf Diabetes getestet?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_42\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_42_1\" name=\"wpforms[fields][42]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_42_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_42_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_42_2\" name=\"wpforms[fields][42]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_42_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_42_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_43-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"43\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_43\">Was war das Ergebnis? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_43\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][43]\" aria-errormessage=\"wpforms-17753-field_43-error\" required><\/div><div id=\"wpforms-17753-field_44-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"44\"><fieldset><legend class=\"wpforms-field-label\">Gibt es Diabetes in der Familie?   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_44\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_44_1\" name=\"wpforms[fields][44]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_44_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_44_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_44_2\" name=\"wpforms[fields][44]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_44_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_44_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_45-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"45\"><fieldset><legend class=\"wpforms-field-label\">Gibt es in der Familie eine Vorgeschichte von Schizophrenie\/Bipolarit\u00e4t oder Angstst\u00f6rungen?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_45\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_45_1\" name=\"wpforms[fields][45]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_45_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_45_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_45_2\" name=\"wpforms[fields][45]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_45_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_45_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_46-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"46\"><fieldset><legend class=\"wpforms-field-label\">Kommt die Creuzfeldt-Jakob-Krankheit in Ihrer Familie vor?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_46\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_46_1\" name=\"wpforms[fields][46]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_46_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_46_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_46_2\" name=\"wpforms[fields][46]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_46_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_46_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_47-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"47\"><fieldset><legend class=\"wpforms-field-label\">Gibt es in Ihrer Familie eine Demenzerkrankung vor dem 60.                <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_47\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_47_1\" name=\"wpforms[fields][47]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_47_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_47_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_47_2\" name=\"wpforms[fields][47]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_47_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_47_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_48-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"48\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"4\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"4\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5  \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-17753-field_49-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"49\"><div id=\"wpforms-17753-field_49\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_49-error\"><h4>Umwelt und Risikobereiche<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_50-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"50\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie irgendwelche Haustiere? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_50\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_50_1\" name=\"wpforms[fields][50]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_50_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_50_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_50_2\" name=\"wpforms[fields][50]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_50_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_50_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_51-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"51\"><fieldset><legend class=\"wpforms-field-label\">Sind Sie in einem au\u00dfereurop\u00e4ischen Land geboren oder haben Sie l\u00e4nger als 5 Jahre in einem au\u00dfereurop\u00e4ischen Land gelebt?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_51\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_51_1\" name=\"wpforms[fields][51]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_51_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_51_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_51_2\" name=\"wpforms[fields][51]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_51_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_51_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_52-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"52\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_52\">Wo und wann? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_52\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][52]\" aria-errormessage=\"wpforms-17753-field_52-error\" required><\/div><div id=\"wpforms-17753-field_53-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"53\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie sich zwischen 1980 und 1996 insgesamt l\u00e4nger als 6 Monate im Vereinigten K\u00f6nigreich aufgehalten? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_53\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_53_1\" name=\"wpforms[fields][53]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_53_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_53_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_53_2\" name=\"wpforms[fields][53]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_53_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_53_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_54-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"54\"><fieldset><legend class=\"wpforms-field-label\">Waren Sie in den letzten zwei Jahren in den Tropen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_54\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_54_1\" name=\"wpforms[fields][54]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_54_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_54_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_54_2\" name=\"wpforms[fields][54]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_54_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_54_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_55-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"55\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_55\">Wo und in welchem Jahr? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_55\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][55]\" aria-errormessage=\"wpforms-17753-field_55-error\" required><\/div><div id=\"wpforms-17753-field_56-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"56\"><fieldset><legend class=\"wpforms-field-label\">Hatten Sie jemals Malaria?         <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_56\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_56_1\" name=\"wpforms[fields][56]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_56_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_56_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_56_2\" name=\"wpforms[fields][56]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_56_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_56_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_57-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"57\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_57\">In welchem Jahr? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_57\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][57]\" aria-errormessage=\"wpforms-17753-field_57-error\" required><\/div><div id=\"wpforms-17753-field_58-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"58\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_58\">Wissen Sie, welcher Typ? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_58\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][58]\" aria-errormessage=\"wpforms-17753-field_58-error\" required><\/div>\t\t<div id=\"wpforms-17753-field_3-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"3\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-17753-field_3\" >Vergangenheit Ihrer vor?<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-17753-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-17753-field_59-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"59\"><fieldset><legend class=\"wpforms-field-label\">Hatten Sie jemals spezielle Infektionskrankheiten?                   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_59\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_59_1\" name=\"wpforms[fields][59]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_59_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_59_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_59_2\" name=\"wpforms[fields][59]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_59_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_59_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_60-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"60\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_60\">Welche Infektionskrankheiten? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_60\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][60]\" aria-errormessage=\"wpforms-17753-field_60-error\" required><\/div><div id=\"wpforms-17753-field_61-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"61\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"5\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"5\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-6  \" data-page=\"6\" style=\"display:none;\"><div id=\"wpforms-17753-field_62-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"62\"><div id=\"wpforms-17753-field_62\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_62-error\"><h4>Berufliches Risiko und Expositionsrisiko<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_63-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"63\"><fieldset><legend class=\"wpforms-field-label\">Besteht bei Ihnen ein berufliches Risiko f\u00fcr durch Blut \u00fcbertragbare Infektionskrankheiten?  (derzeit t\u00e4glicher Patientenkontakt) <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_63\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_63_1\" name=\"wpforms[fields][63]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_63_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_63_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_63_2\" name=\"wpforms[fields][63]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_63_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_63_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_64-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"64\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_64\">Wenn ja, welche? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_64\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][64]\" aria-errormessage=\"wpforms-17753-field_64-error\" required><\/div><div id=\"wpforms-17753-field_65-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"65\"><fieldset><legend class=\"wpforms-field-label\">Hatten Sie jemals eine Nadelstichverletzung? (z. B. eine Verletzung mit einer Nadel, die mit dem Blut einer anderen Person verschmiert war, oder mit einem anderen scharfen, blutverschmierten Gegenstand)?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_65\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_65_1\" name=\"wpforms[fields][65]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_65_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_65_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_65_2\" name=\"wpforms[fields][65]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_65_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_65_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_66-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"66\"><fieldset><legend class=\"wpforms-field-label\">Wurden Ihnen jemals Blutprodukte in den Blutkreislauf verabreicht?   (z. B. Bluttransfusionen)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_66\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_66_1\" name=\"wpforms[fields][66]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_66_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_66_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_66_2\" name=\"wpforms[fields][66]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_66_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_66_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_67-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"67\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_67\">Wann? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17753-field_67\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][67][date]\" aria-errormessage=\"wpforms-17753-field_67-error\" required><a title=\"Datum leeren\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Datum leeren\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17753-field_68-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"68\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"6\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"6\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-7  \" data-page=\"7\" style=\"display:none;\"><div id=\"wpforms-17753-field_69-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"69\"><div id=\"wpforms-17753-field_69\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_69-error\"><h4>Risikoverhalten<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_70-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"70\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie jemals Drogen in Ihre Venen injiziert (intraven\u00f6s)?    <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_70\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_70_1\" name=\"wpforms[fields][70]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_70_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_70_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_70_2\" name=\"wpforms[fields][70]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_70_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_70_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_71-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"71\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie jemals Drogen geschnupft?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_71\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_71_1\" name=\"wpforms[fields][71]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_71_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_71_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_71_2\" name=\"wpforms[fields][71]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_71_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_71_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_72-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"72\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie sich jemals t\u00e4towieren lassen?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_72\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_72_1\" name=\"wpforms[fields][72]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_72_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_72_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_72_2\" name=\"wpforms[fields][72]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_72_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_72_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_73-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"73\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_73\">Wenn ja, in welchem Land wurde sie platziert und wann? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_73\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][73]\" aria-errormessage=\"wpforms-17753-field_73-error\" required><\/div><div id=\"wpforms-17753-field_74-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"74\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie sich jemals ein Piercing\/Ohrringe machen lassen?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_74\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_74_1\" name=\"wpforms[fields][74]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_74_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_74_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_74_2\" name=\"wpforms[fields][74]\" value=\"Nee\" aria-errormessage=\"wpforms-17753-field_74_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_74_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_76-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"76\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_76\">Wenn ja, in welchem Land wurde er gedreht?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_76\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][76]\" aria-errormessage=\"wpforms-17753-field_76-error\" required><\/div><div id=\"wpforms-17753-field_75-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"75\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie sich schon einmal akupunktieren lassen?   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_75\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_75_1\" name=\"wpforms[fields][75]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_75_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_75_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_75_2\" name=\"wpforms[fields][75]\" value=\"Nee\" aria-errormessage=\"wpforms-17753-field_75_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_75_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_77-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"77\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_77\">Wenn ja, in welchem Land? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_77\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][77]\" aria-errormessage=\"wpforms-17753-field_77-error\" required><\/div><div id=\"wpforms-17753-field_78-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"78\"><fieldset><legend class=\"wpforms-field-label\">Wurden Sie jemals mit Wachstumshormonen behandelt?       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_78\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_78_1\" name=\"wpforms[fields][78]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_78_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_78_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_78_2\" name=\"wpforms[fields][78]\" value=\"Nee\" aria-errormessage=\"wpforms-17753-field_78_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_78_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_79-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"79\"><fieldset><legend class=\"wpforms-field-label\"> Hatten Sie schon einmal eine Gewebespende? (z. B. Hornhaut)             <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_79\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_79_1\" name=\"wpforms[fields][79]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_79_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_79_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_79_2\" name=\"wpforms[fields][79]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_79_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_79_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_80-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"80\"><fieldset><legend class=\"wpforms-field-label\">Hatten Sie schon einmal eine Haartransplantation?    <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_80\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_80_1\" name=\"wpforms[fields][80]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_80_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_80_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_80_2\" name=\"wpforms[fields][80]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_80_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_80_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_81-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"81\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie sich schon einmal im Ausland operieren oder klinisch behandeln lassen?       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_81\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_81_1\" name=\"wpforms[fields][81]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_81_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_81_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_81_2\" name=\"wpforms[fields][81]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_81_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_81_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_82-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"82\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_82\">Wenn ja, wo und wann? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_82\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][82]\" aria-errormessage=\"wpforms-17753-field_82-error\" required><\/div><div id=\"wpforms-17753-field_83-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"83\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie im vergangenen Jahr einen neuen Sexualpartner gewonnen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_83\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_83_1\" name=\"wpforms[fields][83]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_83_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_83_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_83_2\" name=\"wpforms[fields][83]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_83_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_83_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_84-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"84\"><fieldset><legend class=\"wpforms-field-label\">Hatten Sie jemals sexuellen Kontakt mit einem intraven\u00f6s Drogenabh\u00e4ngigen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_84\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_84_1\" name=\"wpforms[fields][84]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_84_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_84_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_84_2\" name=\"wpforms[fields][84]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_84_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_84_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_85-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"85\"><fieldset><legend class=\"wpforms-field-label\">Hatten Sie jemals sexuellen Kontakt mit einer Person, bei der anschlie\u00dfend eine HIV\/HTLV\/Hepatitis\/Lues-Infektion festgestellt wurde? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_85\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_85_1\" name=\"wpforms[fields][85]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_85_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_85_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_85_2\" name=\"wpforms[fields][85]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_85_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_85_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_86-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"86\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Womit? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_86\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_86_1\" name=\"wpforms[fields][86]\" value=\"HIV\" aria-errormessage=\"wpforms-17753-field_86_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_86_1\">HIV<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_86_2\" name=\"wpforms[fields][86]\" value=\"Lues\" aria-errormessage=\"wpforms-17753-field_86_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_86_2\">Lues<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_86_3\" name=\"wpforms[fields][86]\" value=\"Hepatitis\" aria-errormessage=\"wpforms-17753-field_86_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_86_3\">Hepatitis<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_86_4\" name=\"wpforms[fields][86]\" value=\"HTLV\" aria-errormessage=\"wpforms-17753-field_86_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_86_4\">HTLV<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_86_5\" name=\"wpforms[fields][86]\" value=\"Sonstiges:\" aria-errormessage=\"wpforms-17753-field_86_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_86_5\">Sonstiges:<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_87-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"87\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_87\">Sonstiges: <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_87\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][87]\" aria-errormessage=\"wpforms-17753-field_87-error\" required><\/div><div id=\"wpforms-17753-field_88-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"88\"><fieldset><legend class=\"wpforms-field-label\">Hatten Sie jemals eine sexuell \u00fcbertragbare Krankheit (STD)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_88\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_88_1\" name=\"wpforms[fields][88]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_88_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_88_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_88_2\" name=\"wpforms[fields][88]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_88_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_88_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_89-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"89\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_89\">Welche? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_89\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][89]\" aria-errormessage=\"wpforms-17753-field_89-error\" required><\/div><div id=\"wpforms-17753-field_90-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"90\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"7\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"7\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-8  \" data-page=\"8\" style=\"display:none;\"><div id=\"wpforms-17753-field_91-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"91\"><div id=\"wpforms-17753-field_91\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_91-error\"><h4>Impfungen<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_92-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"92\"><fieldset><legend class=\"wpforms-field-label\">Wurden Sie gegen Hepatitis A geimpft (d. h. keine einzige Immunglobulinspritze)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_92\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_92_1\" name=\"wpforms[fields][92]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_92_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_92_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_92_2\" name=\"wpforms[fields][92]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_92_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_92_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_94-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"94\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\"> War der Titer ausreichend? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_94\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_94_1\" name=\"wpforms[fields][94]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_94_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_94_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_94_2\" name=\"wpforms[fields][94]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_94_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_94_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_95-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"95\"><fieldset><legend class=\"wpforms-field-label\">Wurden Sie gegen Hepatitis B geimpft (d. h. keine einzige Immunglobulinspritze)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_95\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_95_1\" name=\"wpforms[fields][95]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_95_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_95_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_95_2\" name=\"wpforms[fields][95]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_95_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_95_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_96-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"96\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\"> War der Titer ausreichend? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_96\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_96_1\" name=\"wpforms[fields][96]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_96_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_96_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_96_2\" name=\"wpforms[fields][96]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_96_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_96_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_97-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"97\"><fieldset><legend class=\"wpforms-field-label\">Gibt es Erbkrankheiten in der Familie? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_97\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_97_1\" name=\"wpforms[fields][97]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_97_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_97_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_97_2\" name=\"wpforms[fields][97]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_97_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_97_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_98-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"98\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_98\">Welche? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_98\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][98]\" aria-errormessage=\"wpforms-17753-field_98-error\" required><\/div><div id=\"wpforms-17753-field_99-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"99\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"8\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"8\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-9  \" data-page=\"9\" style=\"display:none;\"><div id=\"wpforms-17753-field_101-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"101\"><div id=\"wpforms-17753-field_101\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_101-error\"><h4>Gesundheit des Darms<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_100-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"100\"><fieldset><legend class=\"wpforms-field-label\">Welche Art von Stuhlgang haben Sie? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_100\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_100_1\" name=\"wpforms[fields][100]\" value=\"Typ 1\" aria-errormessage=\"wpforms-17753-field_100_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_100_1\">Typ 1<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_100_2\" name=\"wpforms[fields][100]\" value=\"Typ 2\" aria-errormessage=\"wpforms-17753-field_100_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_100_2\">Typ 2<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_100_3\" name=\"wpforms[fields][100]\" value=\"Typ 3\" aria-errormessage=\"wpforms-17753-field_100_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_100_3\">Typ 3<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_100_4\" name=\"wpforms[fields][100]\" value=\"Typ 4\" aria-errormessage=\"wpforms-17753-field_100_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_100_4\">Typ 4<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_100_5\" name=\"wpforms[fields][100]\" value=\"Typ 5\" aria-errormessage=\"wpforms-17753-field_100_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_100_5\">Typ 5<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_100_6\" name=\"wpforms[fields][100]\" value=\"Typ 6\" aria-errormessage=\"wpforms-17753-field_100_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_100_6\">Typ 6<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_100_7\" name=\"wpforms[fields][100]\" value=\"Typ 7\" aria-errormessage=\"wpforms-17753-field_100_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_100_7\">Typ 7<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_102-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"102\"><div id=\"wpforms-17753-field_102\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_102-error\"><p><img decoding=\"async\" height=\"568\" width=\"440\" alt=\"\" src=\"https:\/\/gezonde-darmflora.nl\/wp-content\/uploads\/2024\/04\/Picture-1.jpg\" class=\"alignnone wp-image-17408 size-full\" srcset=\"https:\/\/gezonde-darmflora.nl\/wp-content\/uploads\/2024\/04\/Picture-1.jpg 440w, https:\/\/gezonde-darmflora.nl\/wp-content\/uploads\/2024\/04\/Picture-1-232x300.jpg 232w\" sizes=\"(max-width: 440px) 100vw, 440px\" \/><\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_103-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"103\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_103\">Wie oft am Tag haben Sie im Durchschnitt Stuhlgang? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17753-field_103\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][103]\" step=\"any\" aria-errormessage=\"wpforms-17753-field_103-error\" required><\/div><div id=\"wpforms-17753-field_105-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"105\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie einen regelm\u00e4\u00dfigen Stuhlgang? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_105\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_105_1\" name=\"wpforms[fields][105]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_105_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_105_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_105_2\" name=\"wpforms[fields][105]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_105_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_105_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_106-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"106\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Leiden Sie t\u00e4glich unter \u00fcberm\u00e4\u00dfigen Bl\u00e4hungen (Flatulenz)? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_106\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_106_1\" name=\"wpforms[fields][106]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_106_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_106_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_106_2\" name=\"wpforms[fields][106]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_106_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_106_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_107-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"107\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_107\">Wenn ja, wie oft ist dies im Durchschnitt pro Tag der Fall? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17753-field_107\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][107]\" step=\"any\" aria-errormessage=\"wpforms-17753-field_107-error\" required><\/div><div id=\"wpforms-17753-field_108-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"108\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Wurden Sie jemals wegen einer Darminfektion behandelt? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_108\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_108_1\" name=\"wpforms[fields][108]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_108_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_108_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_108_2\" name=\"wpforms[fields][108]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_108_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_108_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_109-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"109\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_109\">Wann war das letzte Mal? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-17753-field_109\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][109][date]\" aria-errormessage=\"wpforms-17753-field_109-error\" required><a title=\"Datum leeren\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Datum leeren\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-17753-field_110-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"110\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie eine chronische Darmerkrankung?  (z. B. Morbus Crohn\/Colitis ulcerosa\/Z\u00f6liakie)     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_110\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_110_1\" name=\"wpforms[fields][110]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_110_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_110_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_110_2\" name=\"wpforms[fields][110]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_110_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_110_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_111-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"111\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_111\">Wenn ja, welche? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_111\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][111]\" aria-errormessage=\"wpforms-17753-field_111-error\" required><\/div><div id=\"wpforms-17753-field_112-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"112\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie jemals Produkte speziell f\u00fcr Ihren Stuhlgang getrunken?  (Aktivit\u00e4ten\/Yakult\/Actimel usw.)       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_112\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_112_1\" name=\"wpforms[fields][112]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_112_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_112_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_112_2\" name=\"wpforms[fields][112]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_112_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_112_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_113-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"113\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_113\">Wie viele Male? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17753-field_113\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][113]\" step=\"any\" aria-errormessage=\"wpforms-17753-field_113-error\" aria-describedby=\"wpforms-17753-field_113-description\" required><div id=\"wpforms-17753-field_113-description\" class=\"wpforms-field-description\">... mal pro Tag<\/div><\/div><div id=\"wpforms-17753-field_114-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"114\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Leiden Sie manchmal (mehr als einmal im Monat) unter schwierigem Stuhlgang (Verstopfung), so dass Sie sich lange anstrengen m\u00fcssen, um den Stuhl herauszubekommen?   <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_114\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_114_1\" name=\"wpforms[fields][114]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_114_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_114_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_114_2\" name=\"wpforms[fields][114]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_114_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_114_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_115-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"115\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_115\">Wenn ja, wie oft ist dies im Durchschnitt pro Monat der Fall? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17753-field_115\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][115]\" step=\"any\" aria-errormessage=\"wpforms-17753-field_115-error\" aria-describedby=\"wpforms-17753-field_115-description\" required><div id=\"wpforms-17753-field_115-description\" class=\"wpforms-field-description\">... mahl<\/div><\/div><div id=\"wpforms-17753-field_116-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"116\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Leiden Sie unter H\u00e4morrhoiden?                  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_116\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_116_1\" name=\"wpforms[fields][116]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_116_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_116_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_116_2\" name=\"wpforms[fields][116]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_116_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_116_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_117-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"117\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie h\u00e4ufig Darmkr\u00e4mpfe?     <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_117\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_117_1\" name=\"wpforms[fields][117]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_117_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_117_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_117_2\" name=\"wpforms[fields][117]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_117_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_117_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_118-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"118\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie jemals Medikamente eingenommen, die den Stuhlgang erleichtern\/verlangsamen?          <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_118\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_118_1\" name=\"wpforms[fields][118]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_118_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_118_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_118_2\" name=\"wpforms[fields][118]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_118_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_118_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_119-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"119\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie jemals bestimmte Nahrungsmittel (Pflaumen\/Ballaststoffe) eingenommen, um den Stuhlgang zu erleichtern?      <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_119\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_119_1\" name=\"wpforms[fields][119]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_119_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_119_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_119_2\" name=\"wpforms[fields][119]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_119_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_119_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_120-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"120\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gibt es in Ihrer Familie Darmerkrankungen?               <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_120\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_120_1\" name=\"wpforms[fields][120]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_120_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_120_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_120_2\" name=\"wpforms[fields][120]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_120_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_120_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_122-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"122\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_122\">Wenn ja, welche und mit wem? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-17753-field_122\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][122]\" aria-errormessage=\"wpforms-17753-field_122-error\" required><\/textarea><\/div><div id=\"wpforms-17753-field_123-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"123\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Gibt es in Ihrer Familie Dickdarmkrebs oder Polypen?       <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_123\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_123_1\" name=\"wpforms[fields][123]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_123_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_123_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_123_2\" name=\"wpforms[fields][123]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_123_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_123_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_124-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"124\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_124\">Mit wem? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_124\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][124]\" aria-errormessage=\"wpforms-17753-field_124-error\" required><\/div><div id=\"wpforms-17753-field_125-container\" class=\"wpforms-field wpforms-field-number wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"125\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_125\">In welchem Alter? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"number\" id=\"wpforms-17753-field_125\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][125]\" step=\"any\" aria-errormessage=\"wpforms-17753-field_125-error\" required><\/div><div id=\"wpforms-17753-field_126-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"126\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"9\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"9\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-10  \" data-page=\"10\" style=\"display:none;\"><div id=\"wpforms-17753-field_127-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"127\"><div id=\"wpforms-17753-field_127\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_127-error\"><h4>Verwendung von Antibiotika<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_128-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"128\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie jemals Antibiotika eingenommen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_128\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_128_1\" name=\"wpforms[fields][128]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_128_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_128_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_128_2\" name=\"wpforms[fields][128]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_128_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_128_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_129-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"129\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie in den letzten drei Monaten Antibiotika eingenommen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_129\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_129_1\" name=\"wpforms[fields][129]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_129_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_129_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_129_2\" name=\"wpforms[fields][129]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_129_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_129_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_131-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"131\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_131\">K\u00f6nnen Sie sich erinnern, welches Antibiotikum? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_131\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][131]\" aria-errormessage=\"wpforms-17753-field_131-error\" required><\/div><div id=\"wpforms-17753-field_132-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"132\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_132\">Wann und f\u00fcr wie viele Tage? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_132\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][132]\" aria-errormessage=\"wpforms-17753-field_132-error\" required><\/div><div id=\"wpforms-17753-field_133-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"133\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie im vergangenen Jahr Antibiotika eingenommen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_133\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_133_1\" name=\"wpforms[fields][133]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_133_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_133_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_133_2\" name=\"wpforms[fields][133]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_133_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_133_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_134-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"134\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_134\">K\u00f6nnen Sie sich erinnern, welches Antibiotikum? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_134\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][134]\" aria-errormessage=\"wpforms-17753-field_134-error\" required><\/div><div id=\"wpforms-17753-field_135-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"135\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_135\">Wann und f\u00fcr wie viele Tage? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-17753-field_135\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][135]\" aria-errormessage=\"wpforms-17753-field_135-error\" required><\/div><div id=\"wpforms-17753-field_136-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"136\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"10\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"10\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-11  \" data-page=\"11\" style=\"display:none;\"><div id=\"wpforms-17753-field_137-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"137\"><div id=\"wpforms-17753-field_137\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_137-error\"><h4>Zus\u00e4tzliche Gesundheitsthemen<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_138-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"138\"><fieldset><legend class=\"wpforms-field-label\">Hatten Sie jemals rektale Blutungen? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_138\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_138_1\" name=\"wpforms[fields][138]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_138_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_138_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_138_2\" name=\"wpforms[fields][138]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_138_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_138_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_140-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-id=\"140\" style=\"display:none;\"><fieldset><legend class=\"wpforms-field-label\">Wurden zus\u00e4tzliche Untersuchungen durchgef\u00fchrt? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_140\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_140_1\" name=\"wpforms[fields][140]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_140_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_140_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_140_2\" name=\"wpforms[fields][140]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_140_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_140_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_141-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"141\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_141\">Was waren die Ergebnisse? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-17753-field_141\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][141]\" aria-errormessage=\"wpforms-17753-field_141-error\" required><\/textarea><\/div><div id=\"wpforms-17753-field_142-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"142\"><fieldset><legend class=\"wpforms-field-label\"> Hatten Sie in den letzten zwei Wochen Fieber? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_142\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_142_1\" name=\"wpforms[fields][142]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_142_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_142_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_142_2\" name=\"wpforms[fields][142]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_142_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_142_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_143-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-id=\"143\"><fieldset><legend class=\"wpforms-field-label\"> Hatten Sie in den letzten 3 Monaten Durchfall? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_143\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_143_1\" name=\"wpforms[fields][143]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_143_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_143_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_143_2\" name=\"wpforms[fields][143]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_143_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_143_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_144-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"144\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_144\"> Wann hat das angefangen und wie lange hat es gedauert? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-17753-field_144\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][144]\" aria-errormessage=\"wpforms-17753-field_144-error\" required><\/textarea><\/div><div id=\"wpforms-17753-field_145-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"145\"><fieldset><legend class=\"wpforms-field-label\"> Leiden Sie unter Allergien? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-17753-field_145\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_145_1\" name=\"wpforms[fields][145]\" value=\"Ja\" aria-errormessage=\"wpforms-17753-field_145_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_145_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-17753-field_145_2\" name=\"wpforms[fields][145]\" value=\"Nein\" aria-errormessage=\"wpforms-17753-field_145_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-17753-field_145_2\">Nein<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-17753-field_146-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"146\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-prev wpforms-disabled\"\n\t\t\t\t\tdata-action=\"prev\" data-page=\"11\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Zur\u00fcck<\/button><button class=\"wpforms-page-button wpforms-page-next wpforms-disabled\"\n\t\t\t\t\tdata-action=\"next\" data-page=\"11\" data-formid=\"17753\" aria-disabled=\"true\" aria-describedby=\"wpforms-error-noscript\">Weiter<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-12 last \" data-page=\"12\" style=\"display:none;\"><div id=\"wpforms-17753-field_147-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"147\"><div id=\"wpforms-17753-field_147\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-17753-field_147-error\"><h4>Erg\u00e4nzungen<\/h4>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-17753-field_148-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"148\"><label class=\"wpforms-field-label\" for=\"wpforms-17753-field_148\">Gibt es noch andere Dinge, die Sie sagen oder erkl\u00e4ren m\u00f6chten?<\/label><textarea id=\"wpforms-17753-field_148\" class=\"wpforms-field-medium\" name=\"wpforms[fields][148]\" aria-errormessage=\"wpforms-17753-field_148-error\" ><\/textarea><\/div><div id=\"wpforms-17753-field_9-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"9\"><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-17753-field_3-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-17753-field_3-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-17753-field_3-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} 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