{"id":870,"date":"2023-04-27T16:43:06","date_gmt":"2023-04-27T13:43:06","guid":{"rendered":"https:\/\/suphantunc.net\/?page_id=870"},"modified":"2023-04-27T17:43:48","modified_gmt":"2023-04-27T14:43:48","slug":"patient-form","status":"publish","type":"page","link":"https:\/\/suphantunc.net\/de\/patient-form\/","title":{"rendered":"Formular f\u00fcr Patienten"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"870\" class=\"elementor elementor-870\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"e-con-with-custom-width elementor-element elementor-element-d9392d2 e-flex e-con-boxed sc_layouts_column_icons_position_left e-con e-parent\" data-id=\"d9392d2\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-126eeb2 elementor-headline--style-highlight sc_fly_static elementor-widget elementor-widget-animated-headline\" data-id=\"126eeb2\" data-element_type=\"widget\" data-settings=\"{&quot;marker&quot;:&quot;underline&quot;,&quot;highlighted_text&quot;:&quot;Form&quot;,&quot;headline_style&quot;:&quot;highlight&quot;,&quot;loop&quot;:&quot;yes&quot;,&quot;highlight_animation_duration&quot;:1200,&quot;highlight_iteration_delay&quot;:8000}\" data-widget_type=\"animated-headline.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-headline\">\n\t\t\t\t\t<span class=\"elementor-headline-plain-text elementor-headline-text-wrapper\">Patient<\/span>\n\t\t\t\t<span class=\"elementor-headline-dynamic-wrapper elementor-headline-text-wrapper\">\n\t\t\t\t\t<span class=\"elementor-headline-dynamic-text elementor-headline-text-active\">Form<\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<\/h3>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"e-con-with-custom-width elementor-element elementor-element-7194e47 e-flex e-con-boxed sc_layouts_column_icons_position_left e-con e-parent\" data-id=\"7194e47\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-7cd6153 e-flex e-con-boxed sc_layouts_column_icons_position_left e-con e-parent\" data-id=\"7cd6153\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-43def6b sc_fly_static elementor-widget elementor-widget-text-editor\" data-id=\"43def6b\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<p><div class=\"forminator-ui forminator-custom-form forminator-custom-form-869 forminator-design--flat forminator-enclosed forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-869\" data-uid=\"69ecdbc0f3f13\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-869\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-869 forminator-design--flat forminator-enclosed forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"869\"\n\t\t\t\t\n\t\t\t\tdata-design=\"flat\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"enclosed\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"69ecdbc0f3f13\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-pagination-progress\" aria-hidden=\"true\"><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-869--page-0\" class=\"forminator-pagination forminator-pagination-start\" aria-labelledby=\"forminator-custom-form-869--page-0-label\" data-step=\"0\" data-label=\"Tamamla (Finish)\" data-name=\"page-break-1\"><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"group-1\" class=\"forminator-field-group forminator-col forminator-col-12\"><label class=\"forminator-label forminator-repeater-label\">Informationen zum Patienten<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Element hinzuf\\u00fcgen&quot;,&quot;remove_text&quot;:&quot;Element entfernen&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69ecdbc0f3f13\" id=\"forminator-field-name-1_69ecdbc0f3f13-label\" class=\"forminator-label\">Vor- und Nachname (Name \/ Nachname) * <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"E.g. John\" id=\"forminator-field-name-1_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-2\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-2_69ecdbc0f3f13\" id=\"forminator-field-text-2_69ecdbc0f3f13-label\" class=\"forminator-label\">T.R. ID-Nummer (t\u00fcrkische ID-Nummer)<\/label><input type=\"text\" name=\"text-2\" value=\"\" placeholder=\"E.g. 11111111111\" id=\"forminator-field-text-2_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" maxlength=\"11\" \/><span id=\"forminator-field-text-2_69ecdbc0f3f13-description\" class=\"forminator-description\"><span data-limit=\"11\" data-type=\"characters\">0 \/ 11<\/span><\/span><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-22\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-22_69ecdbc0f3f13\" id=\"forminator-field-text-22_69ecdbc0f3f13-label\" class=\"forminator-label\">Passnummer (alle L\u00e4nder au\u00dfer t\u00fcrkische Staatsb\u00fcrger)<\/label><input type=\"text\" name=\"text-22\" value=\"\" placeholder=\"\" id=\"forminator-field-text-22_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Geschlecht <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"M\u00e4nnlich (Mann)\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">M\u00e4nnlich (Mann)<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Frau\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Frau<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-4\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-4_69ecdbc0f3f13\" id=\"forminator-field-text-4_69ecdbc0f3f13-label\" class=\"forminator-label\">Geburtstag <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-4\" value=\"\" placeholder=\"E.g. 20\/12\/1990\" id=\"forminator-field-text-4_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-3\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-3_69ecdbc0f3f13\" id=\"forminator-field-text-3_69ecdbc0f3f13-label\" class=\"forminator-label\">Geburtsort <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-3\" value=\"\" placeholder=\"\" id=\"forminator-field-text-3_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-8\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-8_69ecdbc0f3f13\" id=\"forminator-field-text-8_69ecdbc0f3f13-label\" class=\"forminator-label\">Gewicht <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-8\" value=\"\" placeholder=\"E.g. 65 kg\" id=\"forminator-field-text-8_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-9\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-9_69ecdbc0f3f13\" id=\"forminator-field-text-9_69ecdbc0f3f13-label\" class=\"forminator-label\">H\u00f6he <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"text-9\" value=\"\" placeholder=\"E.g. 165 cm\" id=\"forminator-field-text-9_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"1\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69ecdbc0f3f13\" id=\"forminator-field-email-1_69ecdbc0f3f13-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"E.g. john@doe.com\" id=\"forminator-field-email-1_69ecdbc0f3f13\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69ecdbc0f3f13\" id=\"forminator-field-phone-1_69ecdbc0f3f13-label\" class=\"forminator-label\">Telefonnummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"E.g. +1 3004005000\" id=\"forminator-field-phone-1_69ecdbc0f3f13\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-1\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-1_69ecdbc0f3f13\" id=\"forminator-field-textarea-1_69ecdbc0f3f13-label\" class=\"forminator-label\">Notfallkontaktperson <span class=\"forminator-required\">*<\/span><\/label><textarea name=\"textarea-1\" placeholder=\"\" id=\"forminator-field-textarea-1_69ecdbc0f3f13\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-23\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-23_69ecdbc0f3f13\" id=\"forminator-field-text-23_69ecdbc0f3f13-label\" class=\"forminator-label\">Kontakt f\u00fcr Notf\u00e4lle<\/label><input type=\"text\" name=\"text-23\" value=\"\" placeholder=\"\" id=\"forminator-field-text-23_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-2\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-2_69ecdbc0f3f13\" id=\"forminator-field-phone-2_69ecdbc0f3f13-label\" class=\"forminator-label\">Nummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-2\" value=\"\" placeholder=\"E.g. +1 3004005000\" id=\"forminator-field-phone-2_69ecdbc0f3f13\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-24\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-24_69ecdbc0f3f13\" id=\"forminator-field-text-24_69ecdbc0f3f13-label\" class=\"forminator-label\">Beziehung<\/label><input type=\"text\" name=\"text-24\" value=\"\" placeholder=\"\" id=\"forminator-field-text-24_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-2\" class=\"forminator-field-group forminator-col forminator-col-12\"><label class=\"forminator-label forminator-repeater-label\">Woher haben Sie uns?<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Element hinzuf\\u00fcgen&quot;,&quot;remove_text&quot;:&quot;Element entfernen&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69ecdbc0f3f13-label\"><label id=\"forminator-field-checkbox-1-1-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-1-1-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Beratung\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-1-1-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Beratung<\/span><\/label><label id=\"forminator-field-checkbox-1-2-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-1-2-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Medien\/Presse\/Fernsehen\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-1-2-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Medien\/Presse\/Fernsehen<\/span><\/label><label id=\"forminator-field-checkbox-1-3-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-1-3-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Reiseb\u00fcro\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Turizm-Acentas\u0131-(Travel-Agency)\" id=\"forminator-field-checkbox-1-3-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-1-3-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Reiseb\u00fcro<\/span><\/label><label id=\"forminator-field-checkbox-1-4-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-1-4-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Referenz\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Referans-(Reference)\" id=\"forminator-field-checkbox-1-4-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-1-4-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Referenz<\/span><\/label><label id=\"forminator-field-checkbox-1-5-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-1-5-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Soziale Medien\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Sosyal-Medya-(Social-Media)\" id=\"forminator-field-checkbox-1-5-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-1-5-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Soziale Medien<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-6\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-6_69ecdbc0f3f13\" id=\"forminator-field-text-6_69ecdbc0f3f13-label\" class=\"forminator-label\">Andere<\/label><input type=\"text\" name=\"text-6\" value=\"\" placeholder=\"\" id=\"forminator-field-text-6_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-869--page-1\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-869--page-1-label\" aria-hidden=\"true\" data-step=\"1\" data-label=\"Hasta Bilgileri (Patient Information)\" data-name=\"page-break-2\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"group-3\" class=\"forminator-field-group forminator-col forminator-col-12\"><label class=\"forminator-label forminator-repeater-label\">\u0130lgilendi\u011finiz Operasyonlar (Operations You Are Interested In)<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Element hinzuf\\u00fcgen&quot;,&quot;remove_text&quot;:&quot;Element entfernen&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69ecdbc0f3f13-label\"><span id=\"forminator-checkbox-group-69ecdbc0f3f13-label\" class=\"forminator-label\">Estetik (Plastic Surgery)<\/span><label id=\"forminator-field-checkbox-2-1-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-1-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Y\u00fcz Esteti\u011fi (Face Aesthetic)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-1-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Y\u00fcz Esteti\u011fi (Face Aesthetic)<\/span><\/label><label id=\"forminator-field-checkbox-2-2-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-2-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Burun Esteti\u011fi  (Rhinoplasty)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-2-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Burun Esteti\u011fi  (Rhinoplasty)<\/span><\/label><label id=\"forminator-field-checkbox-2-3-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-3-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Meme Esteti\u011fi  (Breast Aesthetic)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Meme-Estetg-(Breast-Aesthetc)\" id=\"forminator-field-checkbox-2-3-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-3-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Meme Esteti\u011fi  (Breast Aesthetic)<\/span><\/label><label id=\"forminator-field-checkbox-2-4-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-4-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Kar\u0131n Germe (Abdominoplasty)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Kar\u0131n-Germe-(Abdomnoplasty)\" id=\"forminator-field-checkbox-2-4-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-4-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Kar\u0131n Germe (Abdominoplasty)<\/span><\/label><label id=\"forminator-field-checkbox-2-5-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-5-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Liposak\u015f\u0131n (Liposuction)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Lposaks\u0131n-(Lposucton)\" id=\"forminator-field-checkbox-2-5-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-5-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Liposak\u015f\u0131n (Liposuction)<\/span><\/label><label id=\"forminator-field-checkbox-2-6-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-6-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Kol Germe (Arm Lift)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Kol-Germe-(Arm-Lft)\" id=\"forminator-field-checkbox-2-6-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-6-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Kol Germe (Arm Lift)<\/span><\/label><label id=\"forminator-field-checkbox-2-7-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-7-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Bacak Germe (Thigh Lift)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Bacak-Germe-(Thgh-Lft)\" id=\"forminator-field-checkbox-2-7-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-7-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bacak Germe (Thigh Lift)<\/span><\/label><label id=\"forminator-field-checkbox-2-8-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-8-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Kulak Esteti\u011fi (Otoplasty)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Kulak-Estetg-(Otoplasty)\" id=\"forminator-field-checkbox-2-8-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-8-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Kulak Esteti\u011fi (Otoplasty)<\/span><\/label><label id=\"forminator-field-checkbox-2-9-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-9-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Anne V\u00fccut Yenileme Operasyonu (Mommy Makeover)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Anne-V\u00fccut-Yenleme-Operasyonu-(Mommy-Makeover)\" id=\"forminator-field-checkbox-2-9-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-9-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Anne V\u00fccut Yenileme Operasyonu (Mommy Makeover)<\/span><\/label><label id=\"forminator-field-checkbox-2-10-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-10-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Boyun Germe (Neck Lift)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Boyun-Germe-(Neck-Lft)\" id=\"forminator-field-checkbox-2-10-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-10-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Boyun Germe (Neck Lift)<\/span><\/label><label id=\"forminator-field-checkbox-2-11-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-11-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Kas Kald\u0131rma (Temporal Lift)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Kas-Kald\u0131rma-(Temporal-Lft)\" id=\"forminator-field-checkbox-2-11-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-11-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Kas Kald\u0131rma (Temporal Lift)<\/span><\/label><label id=\"forminator-field-checkbox-2-12-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-12-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"V\u00fccut Sekillendirme (Liposculpturing)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"V\u00fccut-Sekllendrme-(Lposculpturng)\" id=\"forminator-field-checkbox-2-12-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-12-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">V\u00fccut Sekillendirme (Liposculpturing)<\/span><\/label><label id=\"forminator-field-checkbox-2-13-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-13-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Ya\u011f Enjeksiyonu (Fat Injection BBL)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Yag-Enjeksyonu-(Fat-njecton-BBL)\" id=\"forminator-field-checkbox-2-13-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-13-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ya\u011f Enjeksiyonu (Fat Injection BBL)<\/span><\/label><label id=\"forminator-field-checkbox-2-14-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-2-14-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"V\u00fccut Kitle Indeksi (Body Mass Index)\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"V\u00fccut-Kitle-Indeksi-(Body-Mass-Index)\" id=\"forminator-field-checkbox-2-14-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-2-14-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">V\u00fccut Kitle Indeksi (Body Mass Index)<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"group-4\" class=\"forminator-field-group forminator-col forminator-col-12\"><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Element hinzuf\\u00fcgen&quot;,&quot;remove_text&quot;:&quot;Element entfernen&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-69ecdbc0f3f13-label\"><span id=\"forminator-checkbox-group-69ecdbc0f3f13-label\" class=\"forminator-label\">Medikal Estetik (Non Surgical)<\/span><label id=\"forminator-field-checkbox-3-1-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-3-1-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Botoks (Botox)\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-3-1-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Botoks (Botox)<\/span><\/label><label id=\"forminator-field-checkbox-3-2-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-3-2-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Dolgu (Dermal Fillers)\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-3-2-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dolgu (Dermal Fillers)<\/span><\/label><label id=\"forminator-field-checkbox-3-3-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-3-3-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Ya\u011f Enjeksiyonu (Fat Injection)\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Ya\u011f-Enjeksiyonu-(Fat-Injection)\" id=\"forminator-field-checkbox-3-3-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-3-3-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ya\u011f Enjeksiyonu (Fat Injection)<\/span><\/label><label id=\"forminator-field-checkbox-3-4-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-3-4-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Ask\u0131 \u0130\u015flemleri (Tread Lifting)\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Ask\u0131-Islemleri-(Tread-Lifting)\" id=\"forminator-field-checkbox-3-4-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-3-4-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ask\u0131 \u0130\u015flemleri (Tread Lifting)<\/span><\/label><label id=\"forminator-field-checkbox-3-5-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-3-5-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Mezoterapi\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Mezoterap\" id=\"forminator-field-checkbox-3-5-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-3-5-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mezoterapi<\/span><\/label><label id=\"forminator-field-checkbox-3-6-69ecdbc0f3f13-label\" for=\"forminator-field-checkbox-3-6-69ecdbc0f3f13\" class=\"forminator-checkbox\" title=\"Sa\u00e7 Ekimi (Hair Transplant)\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Sa\u00e7-Ekimi-(Hair-Transplant)\" id=\"forminator-field-checkbox-3-6-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-checkbox-3-6-69ecdbc0f3f13-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Sa\u00e7 Ekimi (Hair Transplant)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-5\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-5_69ecdbc0f3f13\" id=\"forminator-field-text-5_69ecdbc0f3f13-label\" class=\"forminator-label\">Andere<\/label><input type=\"text\" name=\"text-5\" value=\"\" placeholder=\"\" id=\"forminator-field-text-5_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"textarea-2\" class=\"forminator-field-textarea forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-textarea-2_69ecdbc0f3f13\" id=\"forminator-field-textarea-2_69ecdbc0f3f13-label\" class=\"forminator-label\">Notlar (Notes)<\/label><textarea name=\"textarea-2\" placeholder=\"\" id=\"forminator-field-textarea-2_69ecdbc0f3f13\" class=\"forminator-textarea\" rows=\"6\" style=\"min-height:140px;\" ><\/textarea><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-869--page-2\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-869--page-2-label\" aria-hidden=\"true\" data-step=\"2\" data-label=\"Bize Nereden Ula\u015ft\u0131n\u0131z ? (Where Dis You Get Us From ?)\" data-name=\"\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"group-5\" class=\"forminator-field-group forminator-col forminator-col-12\"><label class=\"forminator-label forminator-repeater-label\">Anamnez Sorular\u0131 (Anamnesis Questions)<\/label><div class=\"forminator-all-group-copies forminator-repeater-field\"><div class=\"forminator-grouped-fields\" data-options=\"{&quot;is_repeater&quot;:false,&quot;min_type&quot;:&quot;custom&quot;,&quot;max_type&quot;:&quot;custom&quot;,&quot;min&quot;:1,&quot;max&quot;:9223372036854775807,&quot;add_text&quot;:&quot;Element hinzuf\\u00fcgen&quot;,&quot;remove_text&quot;:&quot;Element entfernen&quot;,&quot;action_element_type&quot;:&quot;button&quot;}\"><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">\u00c7ocugunuz var m\u0131? Varsa yaslar\u0131n\u0131 belirtiniz. E\u011fer k\u00fc\u00e7\u00fck ya\u015fta \u00e7ocu\u011funuz varsa hala emziriyor musunuz? Do you have any children? If yes, please specify their ages. (If you have a young child, are you still breastfeeding?) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-10\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-10_69ecdbc0f3f13\" id=\"forminator-field-text-10_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specify)<\/label><input type=\"text\" name=\"text-10\" value=\"\" placeholder=\"\" id=\"forminator-field-text-10_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Herhangi bir alerjiniz var m\u0131? (Yemek, ila\u00e7 vb.) Varsa belirtiniz. Do you have any allergies? (Food, medication, etc.) If yes, please specify. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-4\" value=\"one\" id=\"forminator-field-radio-4-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-4\" value=\"two\" id=\"forminator-field-radio-4-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-11\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-11_69ecdbc0f3f13\" id=\"forminator-field-text-11_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-11\" value=\"\" placeholder=\"\" id=\"forminator-field-text-11_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">D\u00fczenli kulland\u0131\u011f\u0131n\u0131z bir ila\u00e7 var m\u0131? Varsa belirtiniz. Are you takingng any regular medications? If yes, please specify. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-5\" value=\"one\" id=\"forminator-field-radio-5-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-5\" value=\"two\" id=\"forminator-field-radio-5-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-12\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-12_69ecdbc0f3f13\" id=\"forminator-field-text-12_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-12\" value=\"\" placeholder=\"\" id=\"forminator-field-text-12_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Ge\u00e7irmi\u015f oldu\u011funuz ameliyat var m\u0131? Varsa tarihleriyle beraber belirtiniz. Have you had any surgeries? If yes, please specify the dates. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-6\" value=\"one\" id=\"forminator-field-radio-6-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-6\" value=\"two\" id=\"forminator-field-radio-6-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-13\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-13_69ecdbc0f3f13\" id=\"forminator-field-text-13_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-13\" value=\"\" placeholder=\"\" id=\"forminator-field-text-13_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Kronik hastal\u0131\u011f\u0131n\u0131z var m\u0131? (Ast\u0131m, hipertansiyon, diyabet, herhangi bir kalp rahats\u0131zl\u0131\u011f\u0131, HIV, Hepatit B vb.) Do you have any chronic illnesses? (Asthma, hypertension, diabetes, any heart conditions, HIV, Hepatitis B, etc.) <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-7\" value=\"one\" id=\"forminator-field-radio-7-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-7\" value=\"two\" id=\"forminator-field-radio-7-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-14\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-14_69ecdbc0f3f13\" id=\"forminator-field-text-14_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-14\" value=\"\" placeholder=\"\" id=\"forminator-field-text-14_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-8\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Sigara kullan\u0131yor musunuz? Evet ise s\u0131kl\u0131k belirtiniz. Do you smoke? If yes, how often? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-8-label-1\" for=\"forminator-field-radio-8-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-8\" value=\"one\" id=\"forminator-field-radio-8-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-8-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-8-label-2\" for=\"forminator-field-radio-8-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-8\" value=\"two\" id=\"forminator-field-radio-8-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-8-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-15\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-15_69ecdbc0f3f13\" id=\"forminator-field-text-15_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-15\" value=\"\" placeholder=\"\" id=\"forminator-field-text-15_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-9\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Alkol kullan\u0131yor musunuz? Evet ise s\u0131kl\u0131k belirtiniz. Do you consume alcohol? If yes, how often? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-9-label-1\" for=\"forminator-field-radio-9-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-9\" value=\"one\" id=\"forminator-field-radio-9-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-9-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-9-label-2\" for=\"forminator-field-radio-9-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-9\" value=\"two\" id=\"forminator-field-radio-9-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-9-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-16\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-16_69ecdbc0f3f13\" id=\"forminator-field-text-16_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-16\" value=\"\" placeholder=\"\" id=\"forminator-field-text-16_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-10\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Madde kullan\u0131yor musunuz? Evet ise s\u0131kl\u0131k ve kulland\u0131\u011f\u0131n\u0131z madde t\u00fcr\u00fcn\u00fc belirtiniz. Do you use any drugs? If yes, please specify the frequency and type of drug used. <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-10-label-1\" for=\"forminator-field-radio-10-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-10\" value=\"one\" id=\"forminator-field-radio-10-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-10-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-10-label-2\" for=\"forminator-field-radio-10-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-10\" value=\"two\" id=\"forminator-field-radio-10-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-10-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-17\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-17_69ecdbc0f3f13\" id=\"forminator-field-text-17_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-17\" value=\"\" placeholder=\"\" id=\"forminator-field-text-17_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-11\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Herhangi bir do\u011fum kontrol y\u00f6ntemi kullan\u0131yor musunuz? Are you using any form of birth control? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-11-label-1\" for=\"forminator-field-radio-11-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-11\" value=\"one\" id=\"forminator-field-radio-11-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-11-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-11-label-2\" for=\"forminator-field-radio-11-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-11\" value=\"two\" id=\"forminator-field-radio-11-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-11-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-18\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-18_69ecdbc0f3f13\" id=\"forminator-field-text-18_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-18\" value=\"\" placeholder=\"\" id=\"forminator-field-text-18_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-12\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Herhangi bir vitamin deste\u011fi veya bitkisel ila\u00e7, \u00e7ay vb. t\u00fcketiyor musunuz? Do you take any vitamin supplements or herbal remedies, teas, etc.? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-12-label-1\" for=\"forminator-field-radio-12-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-12\" value=\"one\" id=\"forminator-field-radio-12-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-12-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-12-label-2\" for=\"forminator-field-radio-12-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-12\" value=\"two\" id=\"forminator-field-radio-12-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-12-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-19\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-19_69ecdbc0f3f13\" id=\"forminator-field-text-19_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-19\" value=\"\" placeholder=\"\" id=\"forminator-field-text-19_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-13\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Anne baban\u0131z\u0131n herhangi bir kronik hastal\u0131\u011f\u0131 var m\u0131? Do your parents have any chronic illnesses? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-13-label-1\" for=\"forminator-field-radio-13-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-13\" value=\"one\" id=\"forminator-field-radio-13-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-13-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-13-label-2\" for=\"forminator-field-radio-13-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-13\" value=\"two\" id=\"forminator-field-radio-13-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-13-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-20\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-20_69ecdbc0f3f13\" id=\"forminator-field-text-20_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-20\" value=\"\" placeholder=\"\" id=\"forminator-field-text-20_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-14\" class=\"forminator-field-radio forminator-col forminator-col-12\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-69ecdbc0f3f13-label\"><span id=\"forminator-radiogroup-69ecdbc0f3f13-label\" class=\"forminator-label\">Fazla miktarda kilo de\u011fi\u015fikli\u011finiz oldu mu? Ne kadar zamand\u0131r ayn\u0131 kiloyu koruyorsunuz? Have you experienced significant weight changes? How long have you maintained the same weight? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-14-label-1\" for=\"forminator-field-radio-14-1-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Evet (Yes)\"><input type=\"radio\" name=\"radio-14\" value=\"one\" id=\"forminator-field-radio-14-1-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-14-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Evet (Yes)<\/span><\/label><label id=\"forminator-field-radio-14-label-2\" for=\"forminator-field-radio-14-2-69ecdbc0f3f13\" class=\"forminator-radio forminator-radio-inline\" title=\"Hay\u0131r (No)\"><input type=\"radio\" name=\"radio-14\" value=\"two\" id=\"forminator-field-radio-14-2-69ecdbc0f3f13\" aria-labelledby=\"forminator-field-radio-14-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Hay\u0131r (No)<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"text-21\" class=\"forminator-field-text forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-text-21_69ecdbc0f3f13\" id=\"forminator-field-text-21_69ecdbc0f3f13-label\" class=\"forminator-label\">Belirtiniz (Specifty)<\/label><input type=\"text\" name=\"text-21\" value=\"\" placeholder=\"\" id=\"forminator-field-text-21_69ecdbc0f3f13\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Submit<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"96e7e78e2c\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/de\/wp-json\/wp\/v2\/pages\/870\" \/><input type=\"hidden\" name=\"form_id\" value=\"869\"><input type=\"hidden\" name=\"page_id\" value=\"870\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/suphantunc.net\/de\/patient-form\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"de\"\/><\/form><\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>Formular f\u00fcr Patienten<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"inline_featured_image":false,"footnotes":""},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/suphantunc.net\/de\/wp-json\/wp\/v2\/pages\/870"}],"collection":[{"href":"https:\/\/suphantunc.net\/de\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/suphantunc.net\/de\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/suphantunc.net\/de\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/suphantunc.net\/de\/wp-json\/wp\/v2\/comments?post=870"}],"version-history":[{"count":13,"href":"https:\/\/suphantunc.net\/de\/wp-json\/wp\/v2\/pages\/870\/revisions"}],"predecessor-version":[{"id":886,"href":"https:\/\/suphantunc.net\/de\/wp-json\/wp\/v2\/pages\/870\/revisions\/886"}],"wp:attachment":[{"href":"https:\/\/suphantunc.net\/de\/wp-json\/wp\/v2\/media?parent=870"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}