{"id":898,"date":"2022-10-20T09:24:28","date_gmt":"2022-10-20T09:24:28","guid":{"rendered":"https:\/\/vach.berlin\/?page_id=898"},"modified":"2022-10-20T10:00:37","modified_gmt":"2022-10-20T10:00:37","slug":"ueberweiserformular","status":"publish","type":"page","link":"https:\/\/vach.berlin\/de_de\/fuer-ueberweiser\/ueberweiserformular\/","title":{"rendered":"\u00dcberweiserformular"},"content":{"rendered":"<section class=\"l-section wpb_row us_custom_03db029a us_animate_this height_medium color_secondary\"><div class=\"l-section-overlay\" style=\"background:#14453B\"><\/div><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_flex valign_top type_default stacking_default\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner us_custom_81f21468\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column us_custom_6981e56b\"><div class=\"wpb_wrapper\"><h1>Registrierung f\u00fcr\u00a0\u00dcberweiser<\/h1>\n<\/div><\/div><\/div><\/div><\/div><div class=\"vc_col-sm-4 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><div class=\"wpb_text_column\"><div class=\"wpb_wrapper\"><p>Sehr geehrte Kolleg:innen, wir freuen uns sehr, Ihr Interesse an unseren zahn\u00e4rztlichen Leistungen geweckt zu haben. Nach erfolgter \u00dcbertragung Ihrer Daten richten wir Ihnen einen speziellen gesicherten Online-Bereich ein, in dem Sie Patientendaten und \u00dcberweisungen ablegen k\u00f6nnen. Vielen Dank f\u00fcr Ihr Vertrauen!<\/p>\n<\/div><\/div><\/div><\/div><\/div><div class=\"vc_col-sm-8 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\"><form class=\"w-form  us-field-style_1 us_custom_24ebf989 has_text_color layout_ver show_message_after_sending for_cform us_form_1\" action=\"https:\/\/vach.berlin\/de_de\/de_de\/wp-json\/wp\/v2\/pages\/898\" method=\"post\"><div class=\"w-form-h\"><div class=\"w-form-row for_text required\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t\t\t<input aria-label=\"Name Ihrer Praxis\" type=\"text\" name=\"us_form_1_text_1\" value placeholder=\"Name Ihrer Praxis *\" data-required=\"true\" aria-required=\"true\"\/>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Bitte f\u00fcllen Sie dieses Feld aus.<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_text required cols_2\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t\t\t<input aria-label=\"Ihr Vorname\" type=\"text\" name=\"us_form_1_text_2\" value placeholder=\"Ihr Vorname *\" data-required=\"true\" aria-required=\"true\"\/>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Bitte f\u00fcllen Sie dieses Feld aus.<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_text required cols_2\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t\t\t<input aria-label=\"Ihr Nachname\" type=\"text\" name=\"us_form_1_text_3\" value placeholder=\"Ihr Nachname *\" data-required=\"true\" aria-required=\"true\"\/>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Bitte f\u00fcllen Sie dieses Feld aus.<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_email required cols_2\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t\t\t<input aria-label=\"Ihre E-Mail Adresse\" type=\"email\" name=\"us_form_1_email_1\" value placeholder=\"Ihre E-Mail Adresse *\" data-required=\"true\" aria-required=\"true\"\/>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Bitte gib eine g\u00fcltige E-Mail-Adresse ein.<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_text required cols_2\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t\t\t<input aria-label=\"Ihre Telefonnummer\" type=\"text\" name=\"us_form_1_text_4\" value placeholder=\"Ihre Telefonnummer *\" data-required=\"true\" aria-required=\"true\"\/>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Bitte f\u00fcllen Sie dieses Feld aus.<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_textarea required\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t\t\t<textarea aria-label=\"Praxisadresse\" name=\"us_form_1_textarea_1\" placeholder=\"Praxisadresse *\" data-required=\"true\" aria-required=\"true\"><\/textarea>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Bitte f\u00fcllen Sie dieses Feld aus.<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_select\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t\t\t<select aria-label=\"us_form_1_select_1\" name=\"us_form_1_select_1\">\r\n\t\t\t<option value=\"Gew\u00fcnschte \u00dcberweisung f\u00fcr...\">Gew\u00fcnschte \u00dcberweisung f\u00fcr...<\/option><option value=\"Parodontologie\">Parodontologie<\/option><option value=\"Implantologie\">Implantologie<\/option><option value=\"Endodontie\">Endodontie<\/option><option value=\"Prophylaxe\">Prophylaxe<\/option><option value=\"3D-R\u00f6ntgen\">3D-R\u00f6ntgen<\/option><option value=\"3D-Druck\">3D-Druck<\/option><option value=\"CEREC\">CEREC<\/option><option value=\"Sonstiges\">Sonstiges<\/option>\t\t<\/select>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">W\u00e4hle eine Option<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_textarea\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t\t\t<textarea aria-label=\"Ihre Nachricht an VACH \" name=\"us_form_1_textarea_2\" placeholder=\"Ihre Nachricht an VACH \"><\/textarea>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Bitte f\u00fcllen Sie dieses Feld aus.<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_captcha has_label required\">\r\n\t<div class=\"w-form-row-label\">\r\n\t\t<span>Bitte l\u00f6sen Sie zur Sicherheit folgende Aufgabe: <span>23 + 5 = ?<\/span><\/span>\r\n\t<\/div>\r\n\t<div class=\"w-form-row-field\">\r\n\t\t\t\t<input type=\"hidden\" name=\"us_form_1_captcha_1_hash\" value=\"d6be00a84ecd4e21dcf98b21ebdb8fe2\" \/>\r\n\t\t\t\t<input aria-label=\"Bitte l\u00f6sen Sie zur Sicherheit folgende Aufgabe:\" type=\"text\" name=\"us_form_1_captcha_1\" placeholder data-required=\"true\" aria-required=\"true\"\/>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Bitte geben Sie das Ergebnis ein, um fortzufahren<\/div>\r\n<\/div>\r\n<div class=\"w-form-row for_agreement required\">\r\n\t\t<div class=\"w-form-row-field\">\r\n\t\t\t\t<label>\r\n\t\t\t<input type=\"checkbox\" value=\"1\" data-required=\"true\" aria-required=\"true\" name=\"us_form_1_agreement_1\"\/>\r\n\t\t\t<span>Sie erkl\u00e4ren sich damit einverstanden, da\u00df Ihre Daten zur Bearbeitung Ihres Anliegens verwendet werden. Weitere Informationen und Widerrufshinweise finden Sie in der <a href=\"https:\/\/vach.berlin\/datenschutz\/\">Datenschutzerkl\u00e4rung<\/a>.<\/span>\r\n\t\t<\/label>\r\n\t\t\t<\/div>\r\n\t\t<div class=\"w-form-row-state\">Sie m\u00fcssen den Bedingungen zustimmen, um fortzufahren.<\/div>\r\n<\/div>\r\n<input type=\"hidden\" name=\"action\" value=\"us_ajax_cform\" \/>\r\n<input type=\"hidden\" name=\"post_id\" value=\"0\" \/>\r\n<input type=\"hidden\" name=\"form_index\" value=\"1\" \/>\r\n<div class=\"w-form-row for_submit align_none\"><button class=\"w-btn us-btn-style_17\" type=\"submit\" aria-label=\"Absenden\"><span class=\"g-preloader type_1\"><\/span><span class=\"w-btn-label\">Absenden<\/span><\/button><\/div><\/div><div class=\"w-form-message\"><\/div><div class=\"w-form-json hidden\" onclick='return {&quot;ajaxurl&quot;:&quot;https:\\\/\\\/vach.berlin\\\/wp-admin\\\/admin-ajax.php&quot;,&quot;messages&quot;:{&quot;err_empty&quot;:&quot;Bitte f\\u00fcllen Sie dieses Feld aus.&quot;,&quot;err_size&quot;:&quot;Die Dateigr\\u00f6\\u00dfe darf %s MB nicht \\u00fcberschreiten&quot;,&quot;err_extension&quot;:&quot;Dateityp %s ist nicht zul\\u00e4ssig&quot;,&quot;err_recaptcha_keys&quot;:&quot;reCAPTCHA-Schl\\u00fcssel sind fehlerhaft&quot;}}'><\/div><\/form><\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"Registrierung f\u00fcr\u00a0\u00dcberweiser Sehr geehrte Kolleg:innen, wir freuen uns sehr, Ihr Interesse an unseren zahn\u00e4rztlichen Leistungen geweckt zu haben. Nach erfolgter \u00dcbertragung Ihrer Daten richten wir Ihnen einen speziellen gesicherten Online-Bereich ein, in dem Sie Patientendaten und \u00dcberweisungen ablegen k\u00f6nnen. Vielen Dank f\u00fcr Ihr Vertrauen! Bitte f\u00fcllen Sie dieses Feld aus. Bitte f\u00fcllen Sie dieses Feld...","protected":false},"author":1,"featured_media":0,"parent":78,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-898","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>\u00dcberweiserformular - VACH Zahn\u00e4rzte Berlin Prenzlauer Berg<\/title>\n<meta name=\"description\" content=\"Bereich f\u00fcr \u00fcberweisende Zahn\u00e4rzte. VACH Zahn\u00e4rzte Berlin, Prenzlauer Berg\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/vach.berlin\/de_de\/fuer-ueberweiser\/ueberweiserformular\/\" \/>\n<meta property=\"og:locale\" content=\"de_DE\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"\u00dcberweiserformular - VACH Zahn\u00e4rzte Berlin Prenzlauer Berg\" \/>\n<meta property=\"og:description\" content=\"Bereich f\u00fcr \u00fcberweisende Zahn\u00e4rzte. 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