{"id":8,"date":"2022-09-08T10:50:56","date_gmt":"2022-09-08T08:50:56","guid":{"rendered":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/?page_id=8"},"modified":"2025-10-08T11:18:00","modified_gmt":"2025-10-08T09:18:00","slug":"anmeldeformular","status":"publish","type":"page","link":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/","title":{"rendered":"Anmeldeformular"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"8\" class=\"elementor elementor-8\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e20194b elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e20194b\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-0ff09ad\" data-id=\"0ff09ad\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-8af0447 elementor--h-position-center elementor--v-position-middle elementor-arrows-position-inside elementor-pagination-position-inside elementor-widget elementor-widget-slides\" data-id=\"8af0447\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;transition_speed&quot;:1000,&quot;navigation&quot;:&quot;both&quot;,&quot;infinite&quot;:&quot;yes&quot;,&quot;transition&quot;:&quot;slide&quot;}\" data-widget_type=\"slides.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-swiper\">\n\t\t\t\t\t<div class=\"elementor-slides-wrapper elementor-main-swiper swiper\" role=\"region\" aria-roledescription=\"carousel\" aria-label=\"Slider\" dir=\"ltr\" data-animation=\"fadeInUp\">\n\t\t\t\t<div class=\"swiper-wrapper elementor-slides\">\n\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-repeater-item-cd230d1 swiper-slide\" role=\"group\" aria-roledescription=\"slide\"><div class=\"swiper-slide-bg\" role=\"img\" aria-label=\"DSC04536\"><\/div><div class=\"swiper-slide-inner\" ><div class=\"swiper-slide-contents\"><\/div><\/div><\/div><div class=\"elementor-repeater-item-cb3c906 swiper-slide\" role=\"group\" aria-roledescription=\"slide\"><div class=\"swiper-slide-bg\" role=\"img\" aria-label=\"DSC_1077\"><\/div><div class=\"swiper-slide-inner\" ><div class=\"swiper-slide-contents\"><\/div><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-prev\" role=\"button\" tabindex=\"0\" aria-label=\"Vorheriger Slide\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-chevron-left\"><\/i>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"elementor-swiper-button elementor-swiper-button-next\" role=\"button\" tabindex=\"0\" aria-label=\"N\u00e4chster Slide\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-chevron-right\"><\/i>\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<div class=\"swiper-pagination\"><\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-798011b elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"798011b\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;step_type&quot;:&quot;none&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" id=\"anmeldeformular\" name=\"Anmeldeformular\" aria-label=\"Anmeldeformular\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"8\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"798011b\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"8\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_899e0ca elementor-col-100\">\n\t\t\t\t\tAngaben zum Besitzer \/Auftraggeber:\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-anrede elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-anrede\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAnrede\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Herr\" id=\"form-field-anrede-0\" name=\"form_fields[anrede][]\"> <label for=\"form-field-anrede-0\">Herr<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Frau\" id=\"form-field-anrede-1\" name=\"form_fields[anrede][]\"> <label for=\"form-field-anrede-1\">Frau<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_1c365d3 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1c365d3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_1c365d3]\" id=\"form-field-field_1c365d3\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-Vorname elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Vorname\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVorname\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[Vorname]\" id=\"form-field-Vorname\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_da88da2 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_da88da2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStra\u00dfe\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_da88da2]\" id=\"form-field-field_da88da2\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-PLZ elementor-col-20 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-PLZ\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPLZ\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[PLZ]\" id=\"form-field-PLZ\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-Ort elementor-col-30 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-Ort\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOrt\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[Ort]\" id=\"form-field-Ort\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_d2e3fb3 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d2e3fb3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTelefon \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_d2e3fb3]\" id=\"form-field-field_d2e3fb3\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tE-Mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_899e0ca elementor-col-100\">\n\t\t\t\t\tAngaben zum Tier:\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_10afc60 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_10afc60\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRufname\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_10afc60]\" id=\"form-field-field_10afc60\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_186a96c elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_186a96c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeschlecht\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_186a96c]\" id=\"form-field-field_186a96c\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"bitte ausw\u00e4hlen\">bitte ausw\u00e4hlen<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"weiblich kastriert\">weiblich kastriert<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"m\u00e4nnlich kastriert\">m\u00e4nnlich kastriert<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"weiblich unkastriert\">weiblich unkastriert<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"m\u00e4nnlich unkastriert\">m\u00e4nnlich unkastriert<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_tierart elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_tierart\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTierart\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_tierart]\" id=\"form-field-field_tierart\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-rasse elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-rasse\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRasse\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[rasse]\" id=\"form-field-rasse\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_abb1570 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_abb1570\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBei Katze: Freig\u00e4nger?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_abb1570-0\" name=\"form_fields[field_abb1570][]\"> <label for=\"form-field-field_abb1570-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_abb1570-1\" name=\"form_fields[field_abb1570][]\"> <label for=\"form-field-field_abb1570-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c685b3a elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c685b3a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFarben\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c685b3a]\" id=\"form-field-field_c685b3a\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_53fbbbb elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_53fbbbb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGewicht in kg\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_53fbbbb]\" id=\"form-field-field_53fbbbb\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-field_a7ad241 elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a7ad241\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeburtsdatum\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[field_a7ad241]\" id=\"form-field-field_a7ad241\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field\" placeholder=\"TT.MM.JJJJ\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_740c501 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_740c501\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tT\u00e4towierung oder Chipnummer\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_740c501]\" id=\"form-field-field_740c501\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a1e40bd elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a1e40bd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHeimtierausweis-Nummer\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a1e40bd]\" id=\"form-field-field_a1e40bd\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_0a03aa7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0a03aa7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tUnvertr\u00e4glichkeiten und chronische Erkrankungen sowie bisherige Medikation\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_0a03aa7]\" id=\"form-field-field_0a03aa7\" rows=\"6\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_f742eaa elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f742eaa\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRein formal, n\u00f6tige Frage: Dient das Tier zur Lebensmittelgewinnung?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_f742eaa-0\" name=\"form_fields[field_f742eaa][]\"> <label for=\"form-field-field_f742eaa-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_f742eaa-1\" name=\"form_fields[field_f742eaa][]\"> <label for=\"form-field-field_f742eaa-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_072f454 elementor-col-100\">\n\t\t\t\t\tVerf\u00fcgen Sie \u00fcber eine Tierkrankenversicherung? Wenn ja, bitte geben Sie an:\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_0010413 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0010413\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVersicherungsgesellschaft:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_0010413]\" id=\"form-field-field_0010413\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_d471df6 elementor-col-100\">\n\t\t\t\t\tUnsere Leistungen werden nach der Geb\u00fchrenordnung f\u00fcr Tier\u00e4rzte (GOT) berechnet. Gerne senden wir Ihnen auf Wunsch einen Link zur Einsicht der GOT zu. Das Honorar ist unmittelbar an jedem Behandlungstag zu entrichten.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_1a0b993 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_1a0b993\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIhre bevorzugte Zahlungsmethode\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Barzahlung\" id=\"form-field-field_1a0b993-0\" name=\"form_fields[field_1a0b993][]\"> <label for=\"form-field-field_1a0b993-0\">Barzahlung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"ec-cash \" id=\"form-field-field_1a0b993-1\" name=\"form_fields[field_1a0b993][]\"> <label for=\"form-field-field_1a0b993-1\">ec-cash <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_e31644a elementor-col-50\">\n\t\t\t\t\tBitte beachten Sie: Wird Ihr Termin nicht mind. 24 Stunden zuvor abgesagt, erheben wir eine Ausfallpauschale.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_e62e45e elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e62e45e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\t<b>Behandlungsvertrag<\/b>\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_e62e45e]\" id=\"form-field-field_e62e45e\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_e62e45e\">Ich versichere, dass ich Halter des Tieres und deshalb berechtigt bin, einen Vertrag \u00fcber die Durchf\u00fchrung erforderlicher Behandlungen und Operationen zu schlie\u00dfen, ich versichere ferner, dass ich willens und in der Lage bin, die dadurch entstehenden Kosten zu tragen. Ich erkl\u00e4re in diesem Zusammenhang, dass ich mich zum Zeitpunkt dieser Erkl\u00e4rung in keinem gerichtlichen Schuldenverfahren befinde, und dass das Schuldnerverzeichnis des f\u00fcr mich zust\u00e4ndigen Amtsgerichts keine Eintragungen \u00fcber meine Person aufweist. Sofern ich nicht Halter des Tieres bin, versichere ich, im ausdr\u00fccklichen Auftrag des Tierhalters zu handeln. Fehlt es an einer Bevollm\u00e4chtigung oder stellt der Tierhalter eine Bevollm\u00e4chtigung in Abrede, best\u00e4tige ich hiermit, dass ich f\u00fcr die entstehenden Kosten aus der Behandlung aufkommen werde.\nSoweit es zur Diagnosefindung erforderlich ist, erm\u00e4chtige ich den Inhaber und die Mitarbeiter der Praxis, Leistungen Dritter (Labors, Spezialuntersuchungsanstalten u \u00e4.) in Absprache mit mir, in meinem Namen und auf meine Rechnung in Anspruch zu nehmen. Ich zahle die entstehenden Kosten sofort in bar oder per EC-Karte. Mir ist bekannt, dass der Praxis ein Zur\u00fcckbehaltungsrecht an dem behandelten Tier zusteht, wenn ich nicht bereit oder dazu in der Lage bin, die durch die Behandlung des Tieres entstandenen Kosten in bar oder per EC-Karte zu zahlen.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_4bc4b11 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_4bc4b11]\" id=\"form-field-field_4bc4b11\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_4bc4b11\">Mit diesem Formular willige ich ein, dass die Tierarztpraxis Monika Volbracht meine auf der Anmeldung angegebenen personenbezogenen Daten zum Zwecke der Durchf\u00fchrung eines tier\u00e4rztlichen Behandlungsvertrages auf der Grundlage gesetzlicher Berechtigungen erhebt. F\u00fcr jede dar\u00fcber hinausgehende Nutzung der personenbezogenen Daten und die Erhebung zus\u00e4tzlicher Informationen, ebenso f\u00fcr eine Weiterleitung an Dritte, bedarf es regelm\u00e4\u00dfig einer Einwilligung. \n<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_064ef24 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_064ef24]\" id=\"form-field-field_064ef24\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_064ef24\">Ich willige ein, dass die erhobenen Daten auch f\u00fcr zuk\u00fcnftige Behandlungsvertr\u00e4ge genutzt werden d\u00fcrfen.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_4b57fc8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4b57fc8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIch willige ein, dass die erhobenen Daten, soweit erforderlich und notwendig, im Rahmen tier\u00e4rztlicher \u00dcberweisungen an andere Tierarztpraxen, -kliniken \u00fcbermittelt werden d\u00fcrfen.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_4b57fc8-0\" name=\"form_fields[field_4b57fc8][]\"> <label for=\"form-field-field_4b57fc8-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_4b57fc8-1\" name=\"form_fields[field_4b57fc8][]\"> <label for=\"form-field-field_4b57fc8-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_4bc6da1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4bc6da1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIch willige ein, dass die erhobenen Daten, soweit erforderlich und notwendig, im Rahmen weiterf\u00fchrender Diagnostik an Untersuchungslabore und Institute \u00fcbermittelt werden d\u00fcrfen.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_4bc6da1-0\" name=\"form_fields[field_4bc6da1][]\"> <label for=\"form-field-field_4bc6da1-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_4bc6da1-1\" name=\"form_fields[field_4bc6da1][]\"> <label for=\"form-field-field_4bc6da1-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_26932cc elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_26932cc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIch willige ein, dass meine genannten personenbezogenen Daten sowie Daten der erbrachten tier\u00e4rztlichen Leistungen an eine Verrechnungsstelle \u00fcbermittelt werden d\u00fcrfen, falls dies zu Abrechnungszwecken erforderlich sein sollte. \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_26932cc-0\" name=\"form_fields[field_26932cc][]\"> <label for=\"form-field-field_26932cc-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_26932cc-1\" name=\"form_fields[field_26932cc][]\"> <label for=\"form-field-field_26932cc-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_faa9bfb elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_faa9bfb\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIch willige ein, dass mich die Tierarztpraxis Monika Volbracht telefonisch \u00fcber Laborergebnisse und Terminplanung informiert.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_faa9bfb-0\" name=\"form_fields[field_faa9bfb][]\"> <label for=\"form-field-field_faa9bfb-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_faa9bfb-1\" name=\"form_fields[field_faa9bfb][]\"> <label for=\"form-field-field_faa9bfb-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_7e18e35 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7e18e35\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIch willige ein, dass mich die Tierarztpraxis Monika Volbracht per Post\/Mail (Newsletter)  informieren darf (z.B. Impferinnerungen).\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_7e18e35-0\" name=\"form_fields[field_7e18e35][]\"> <label for=\"form-field-field_7e18e35-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_7e18e35-1\" name=\"form_fields[field_7e18e35][]\"> <label for=\"form-field-field_7e18e35-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_0888dc2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_0888dc2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIch willige ein, dass die erhobenen Daten auch im Rahmen einer Weiterf\u00fchrung der Praxis durch einen Nachfolger weiter bestimmungsgem\u00e4\u00df genutzt werden d\u00fcrfen.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_0888dc2-0\" name=\"form_fields[field_0888dc2][]\"> <label for=\"form-field-field_0888dc2-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_0888dc2-1\" name=\"form_fields[field_0888dc2][]\"> <label for=\"form-field-field_0888dc2-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_f1e357a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f1e357a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIch willige ein, dass meine personenbezogenen Daten, die Daten des angegebenen Tieres und die Chipnummer des Transponders an das TASSO-Haustierzentralregister f\u00fcr die Bundesrepublik Deutschland e.V., Otto-Volger-Str. 15, 65843 Sulzbach \u00fcbermittelt und dort gespeichert werden.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_f1e357a-0\" name=\"form_fields[field_f1e357a][]\"> <label for=\"form-field-field_f1e357a-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_f1e357a-1\" name=\"form_fields[field_f1e357a][]\"> <label for=\"form-field-field_f1e357a-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_5d8fc0d elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5d8fc0d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIch willige ein, dass meine Daten sowie Behandlungen im Falle einer Tierkrankenversicherung an diese \u00fcbermittelt werden d\u00fcrfen.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ja\" id=\"form-field-field_5d8fc0d-0\" name=\"form_fields[field_5d8fc0d][]\"> <label for=\"form-field-field_5d8fc0d-0\">Ja<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nein\" id=\"form-field-field_5d8fc0d-1\" name=\"form_fields[field_5d8fc0d][]\"> <label for=\"form-field-field_5d8fc0d-1\">Nein<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_df17a9d elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_df17a9d]\" id=\"form-field-field_df17a9d\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_df17a9d\">Ich habe die \n<a href=\"https:\/\/www.tierarztpraxis-volbracht.de\/datenschutz\" target=\"_blank\" rel=\"noopener noreferrer\">Datenschutzerkl\u00e4rung<\/a> gelesen, verstanden und stimme der Vorgehensweise zu.\n<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text\">\n\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f6c73f9]\" id=\"form-field-field_f6c73f9\" class=\"elementor-field elementor-size-md \" style=\"display:none !important;\">\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_de833a1 elementor-col-100\">\n\t\t\t\t\tVoraussetzung zur Absendung des Formulars: Bitte akzeptieren Sie unsere Cookies, ansonsten k\u00f6nnte das Formular geblockt werden.\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_ef16a66 elementor-col-100 recaptcha_v3-inline\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_ef16a66\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LeD4O8pAAAAABkmOpxKHgbMUgfMkHfJGsVNMN1F\" data-type=\"v3\" data-action=\"Form\" data-badge=\"inline\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_dae0b0b elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_dae0b0b]\" id=\"form-field-field_dae0b0b\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Absenden<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-16fd245 elementor-widget elementor-widget-heading\" data-id=\"16fd245\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Anmeldeformular f\u00fcr unsere Neukunden<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Anmeldeformular f\u00fcr unsere Neukunden<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-8","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/wp-json\/wp\/v2\/pages\/8","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/wp-json\/wp\/v2\/comments?post=8"}],"version-history":[{"count":429,"href":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/wp-json\/wp\/v2\/pages\/8\/revisions"}],"predecessor-version":[{"id":579,"href":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/wp-json\/wp\/v2\/pages\/8\/revisions\/579"}],"wp:attachment":[{"href":"https:\/\/www.tierarztpraxis-volbracht.de\/formulare\/wp-json\/wp\/v2\/media?parent=8"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}