{"id":6725,"date":"2025-06-14T11:08:32","date_gmt":"2025-06-14T11:08:32","guid":{"rendered":"https:\/\/epccheckup.com\/?page_id=6725"},"modified":"2025-06-24T15:12:09","modified_gmt":"2025-06-24T15:12:09","slug":"elementor-%e9%a1%b5%e9%9d%a2-6725","status":"publish","type":"page","link":"https:\/\/epccheckup.com\/zh\/elementor-seite-6725\/","title":{"rendered":"\u6d4b\u8bd5\u8868"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"6725\" class=\"elementor elementor-6725\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-204d12d6 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"204d12d6\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-17d7d117 elementor-widget__width-initial elementor-widget elementor-widget-heading\" data-id=\"17d7d117\" 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 zum Check-Up<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-60ab7a0d elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"60ab7a0d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-cbec853 e-con-full e-flex wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-child\" data-id=\"cbec853\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-335171e0 elementor-widget elementor-widget-text-editor\" data-id=\"335171e0\" data-element_type=\"widget\" data-e-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\t\t<p>Sehr geehrter Teilnehmer,<br><br><\/p>\n<p>Sie haben sich zur Teilnahme an einer Ma\u00dfnahme zur betrieblichen Gesundheitsmanagement (BGM) im European Prevention Center (EPC-GmbH) entschlossen. Ihr Arbeitgeber hat mit EPC einen Rahmenvertrag \u00fcber das Angebot von medizinischen Vorsorgeleistungen (Check-Ups) geschlossen und sich zur \u00dcbernahme der Behandlungskosten bereit erkl\u00e4rt.&nbsp;Die Abrechnung erfolgt gegen\u00fcber Ihrem Arbeitgeber durch \u00dcbersendung einer Rechnung f\u00fcr die Leistungen der EPC. Diese Rechnung enth\u00e4lt weder Diagnosen noch Ziffern, sondern nur Ihren Namen, Ihr Geburtsdatum, das Datum der Behandlung und einen Gesamtpreis. Dies dient dem Datenschutz und der Einhaltung der \u00e4rztlichen Schweigepflicht. Anhand dieser Rechnung kann die \u00dcbernahme der Kosten durch Zahlung Ihres Arbeitgebers direkt an EPC erfolgen.<br><br><\/p>\n<p style=\"font-size: 16px; font-style: normal; font-weight: 400;\"><em><span style=\"font-weight: bolder;\">Erkl\u00e4rung des Teilnehmers:<\/span><\/em><\/p>\n<p style=\"font-size: 16px; font-style: normal; font-weight: 400;\">Mit der hier dargestellten Vorgehensweise bin ich einverstanden. Ich versichere durch meine Unterschrift weiterhin, dass ich berechtigt bin die medizinischen Vorsorgeleistungen, wie oben angegeben, auf Kosten und Rechnung meines&nbsp; Arbeitgebers in Anspruch zu nehmen. Eine Aufstellung der einzelnen Leistungen habe ich im Vorfeld erhalten.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-68612fb1 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"68612fb1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\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-77a950ec elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"77a950ec\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;N\\u00e4chster&quot;,&quot;step_previous_label&quot;:&quot;Voriger&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&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\" name=\"AnmeldungCheckUp2\" aria-label=\"AnmeldungCheckUp2\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"6725\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"77a950ec\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\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-step elementor-field-group elementor-column elementor-field-group-field_03a754c elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Angaben zum Arbeitgeber\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\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_ad7559c]\" id=\"form-field-field_ad7559c\" 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-text elementor-field-group elementor-column elementor-field-group-name elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tArbeitgeber \/ Firma oder Privatkunde\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[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Name der Firma bzw. des Arbeitgebers oder Anmeldung als Privatkunde\" 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_ed6bc33 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed6bc33\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRechnungsadresse  bzw. Adresse des Arbeitgebers\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_ed6bc33]\" id=\"form-field-field_ed6bc33\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Stra\u00dfe und Hausnummer\" 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_46d2868 elementor-col-30 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_46d2868]\" id=\"form-field-field_46d2868\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"PLZ\" 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_94245b0 elementor-col-70 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_94245b0]\" id=\"form-field-field_94245b0\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Ort\" 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-date elementor-field-group elementor-column elementor-field-group-field_3632699 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3632699\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDatum des Checkups\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_3632699]\" id=\"form-field-field_3632699\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field\" placeholder=\"Datum\" required=\"required\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\" min=\"2024-05-01\">\n\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_be46637 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_be46637\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tArt des Checkups\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<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_be46637]\" id=\"form-field-field_be46637\" class=\"elementor-field-textual elementor-size-md\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Basic\">Basic<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Basic Plus\">Basic Plus<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Standard\">Standard<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Executive\">Executive<\/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-step elementor-field-group elementor-column elementor-field-group-field_ed01adc elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Angaben zum Teilnehmer\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\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_05046d1 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_05046d1\" 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\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<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_05046d1]\" id=\"form-field-field_05046d1\" class=\"elementor-field-textual elementor-size-md\">\n\t\t\t\t\t\t\t\t\t<option value=\"Herr\">Herr<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Frau\">Frau<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Divers\">Divers<\/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_396a61d elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_396a61d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTitel\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_396a61d]\" id=\"form-field-field_396a61d\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Dr.\">\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_473a014 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_473a014\" 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[field_473a014]\" id=\"form-field-field_473a014\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Max\" 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_a56c820 elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a56c820\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNachname\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_a56c820]\" id=\"form-field-field_a56c820\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Mustermann\" 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_8a6fce4 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8a6fce4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdresse des Teilnehmers\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_8a6fce4]\" id=\"form-field-field_8a6fce4\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Luise-Rainer-Stra\u00dfe  6 -10\">\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_Teilnehmer elementor-col-30\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[PLZ_Teilnehmer]\" id=\"form-field-PLZ_Teilnehmer\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"PLZ\">\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_Teilnehmer elementor-col-70\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[Ort_Teilnehmer]\" id=\"form-field-Ort_Teilnehmer\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Ort\">\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_d8bbbf9 elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d8bbbf9\" 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_d8bbbf9]\" id=\"form-field-field_d8bbbf9\" class=\"elementor-field elementor-size-md  elementor-field-textual elementor-date-field\" placeholder=\"01.08.1973\" required=\"required\" 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-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\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 (Gesch\u00e4ftlich)\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\" placeholder=\"E-Mail\" 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-field_d26cfff elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d26cfff\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tE-Mail (Privat)\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[field_d26cfff]\" id=\"form-field-field_d26cfff\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"E-Mail\">\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-tel elementor-field-group elementor-column elementor-field-group-field_9e820a5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9e820a5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTelefon (Mobil - Privat)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_9e820a5]\" id=\"form-field-field_9e820a5\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"+4915712345678\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\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-Zustimmung_Termine elementor-col-100\">\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[Zustimmung_Termine]\" id=\"form-field-Zustimmung_Termine\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" checked=\"checked\">\n\t\t\t\t<label for=\"form-field-Zustimmung_Termine\">Ich bin damit einverstanden per E-Mail \/ SMS \/ Brief \u00fcber die M\u00f6glichkeit einer erneuten Terminbuchung \/ Wiedervorstellung informiert zu werden.<\/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-Zustimmung_Newsletter elementor-col-100\">\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[Zustimmung_Newsletter]\" id=\"form-field-Zustimmung_Newsletter\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" checked=\"checked\">\n\t\t\t\t<label for=\"form-field-Zustimmung_Newsletter\">Ich bin damit einverstanden per E-Mail \/ SMS \/ Brief Informationen \u00fcber Neuigkeiten aus dem EPC zu den Themen Herz- und Pr\u00e4ventionsmedizin zu erhalten<\/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-OptOut elementor-col-100\">\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[OptOut]\" id=\"form-field-OptOut\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\">\n\t\t\t\t<label for=\"form-field-OptOut\">Ich m\u00f6chte keine E-Mails \/ SMS \/ Briefe erhalten<\/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-step elementor-field-group elementor-column elementor-field-group-who0 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"WHO-Questionnaire\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-who1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-who1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn den letzten zwei Wochen war ich froh und guter Laune\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=\"radio\" value=\"Die ganze Zeit\" id=\"form-field-who1-0\" name=\"form_fields[who1]\"> <label for=\"form-field-who1-0\">Die ganze Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Meistens\" id=\"form-field-who1-1\" name=\"form_fields[who1]\"> <label for=\"form-field-who1-1\">Meistens<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Etwas mehr als die H\u00e4lfte der Zeit\" id=\"form-field-who1-2\" name=\"form_fields[who1]\"> <label for=\"form-field-who1-2\">Etwas mehr als die H\u00e4lfte der Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Ab und zu\" id=\"form-field-who1-3\" name=\"form_fields[who1]\"> <label for=\"form-field-who1-3\">Ab und zu<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Zu keinem Zeitpunkt\" id=\"form-field-who1-4\" name=\"form_fields[who1]\"> <label for=\"form-field-who1-4\">Zu keinem Zeitpunkt<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-who2 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-who2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn den letzten zwei Wochen  habe ich mich ruhig und entspannt gef\u00fchlt \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=\"radio\" value=\"Die ganze Zeit\" id=\"form-field-who2-0\" name=\"form_fields[who2]\"> <label for=\"form-field-who2-0\">Die ganze Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Meistens\" id=\"form-field-who2-1\" name=\"form_fields[who2]\"> <label for=\"form-field-who2-1\">Meistens<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Etwas mehr als die H\u00e4lfte der Zeit\" id=\"form-field-who2-2\" name=\"form_fields[who2]\"> <label for=\"form-field-who2-2\">Etwas mehr als die H\u00e4lfte der Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Ab und zu\" id=\"form-field-who2-3\" name=\"form_fields[who2]\"> <label for=\"form-field-who2-3\">Ab und zu<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Zu keinem Zeitpunkt\" id=\"form-field-who2-4\" name=\"form_fields[who2]\"> <label for=\"form-field-who2-4\">Zu keinem Zeitpunkt<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-who3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-who3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn den letzten zwei Wochen habe ich mich energisch und aktiv  gef\u00fchlt\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=\"radio\" value=\"Die ganze Zeit\" id=\"form-field-who3-0\" name=\"form_fields[who3]\"> <label for=\"form-field-who3-0\">Die ganze Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Meistens\" id=\"form-field-who3-1\" name=\"form_fields[who3]\"> <label for=\"form-field-who3-1\">Meistens<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Etwas mehr als die H\u00e4lfte der Zeit\" id=\"form-field-who3-2\" name=\"form_fields[who3]\"> <label for=\"form-field-who3-2\">Etwas mehr als die H\u00e4lfte der Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Ab und zu\" id=\"form-field-who3-3\" name=\"form_fields[who3]\"> <label for=\"form-field-who3-3\">Ab und zu<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Zu keinem Zeitpunkt\" id=\"form-field-who3-4\" name=\"form_fields[who3]\"> <label for=\"form-field-who3-4\">Zu keinem Zeitpunkt<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-who4 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-who4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn den letzten zwei Wochen habe ich mich beim Aufwachen  frisch und ausgeruht gef\u00fchlt\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=\"radio\" value=\"Die ganze Zeit\" id=\"form-field-who4-0\" name=\"form_fields[who4]\"> <label for=\"form-field-who4-0\">Die ganze Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Meistens\" id=\"form-field-who4-1\" name=\"form_fields[who4]\"> <label for=\"form-field-who4-1\">Meistens<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Etwas mehr als die H\u00e4lfte der Zeit\" id=\"form-field-who4-2\" name=\"form_fields[who4]\"> <label for=\"form-field-who4-2\">Etwas mehr als die H\u00e4lfte der Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Ab und zu\" id=\"form-field-who4-3\" name=\"form_fields[who4]\"> <label for=\"form-field-who4-3\">Ab und zu<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Zu keinem Zeitpunkt\" id=\"form-field-who4-4\" name=\"form_fields[who4]\"> <label for=\"form-field-who4-4\">Zu keinem Zeitpunkt<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-who5 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-who5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIn den letzten zwei Wochen war mein Alltag voller Dinge, die  mich interessieren\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=\"radio\" value=\"Die ganze Zeit\" id=\"form-field-who5-0\" name=\"form_fields[who5]\"> <label for=\"form-field-who5-0\">Die ganze Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Meistens\" id=\"form-field-who5-1\" name=\"form_fields[who5]\"> <label for=\"form-field-who5-1\">Meistens<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Etwas mehr als die H\u00e4lfte der Zeit\" id=\"form-field-who5-2\" name=\"form_fields[who5]\"> <label for=\"form-field-who5-2\">Etwas mehr als die H\u00e4lfte der Zeit<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Ab und zu\" id=\"form-field-who5-3\" name=\"form_fields[who5]\"> <label for=\"form-field-who5-3\">Ab und zu<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Zu keinem Zeitpunkt\" id=\"form-field-who5-4\" name=\"form_fields[who5]\"> <label for=\"form-field-who5-4\">Zu keinem Zeitpunkt<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_a13e77b elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Anamnesebogen\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\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_cf9fe1a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_cf9fe1a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVorerkrankungen\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=\"Fettstoffwechselst\u00f6rung  \" id=\"form-field-field_cf9fe1a-0\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-0\">Fettstoffwechselst\u00f6rung  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Schlaganfall\" id=\"form-field-field_cf9fe1a-1\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-1\">Schlaganfall<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Herzrhythmusst\u00f6rungen  \" id=\"form-field-field_cf9fe1a-2\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-2\">Herzrhythmusst\u00f6rungen  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Andere Erkrankungen des Herzens\" id=\"form-field-field_cf9fe1a-3\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-3\">Andere Erkrankungen des Herzens<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Arterielle Verschlusskrankheit  \" id=\"form-field-field_cf9fe1a-4\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-4\">Arterielle Verschlusskrankheit  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Erkrankung der Speiser\u00f6hre\" id=\"form-field-field_cf9fe1a-5\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-5\">Erkrankung der Speiser\u00f6hre<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Erkrankungen des Magens  \" id=\"form-field-field_cf9fe1a-6\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-6\">Erkrankungen des Magens  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Erkrankung des Darmtraktes\" id=\"form-field-field_cf9fe1a-7\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-7\">Erkrankung des Darmtraktes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Erkrankungen der Bauchspeicheldr\u00fcse  \" id=\"form-field-field_cf9fe1a-8\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-8\">Erkrankungen der Bauchspeicheldr\u00fcse  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nierenerkrankungen\" id=\"form-field-field_cf9fe1a-9\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-9\">Nierenerkrankungen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Blasenerkrankungen  \" id=\"form-field-field_cf9fe1a-10\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-10\">Blasenerkrankungen  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Prostata leiden\" id=\"form-field-field_cf9fe1a-11\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-11\">Prostata leiden<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Schilddr\u00fcsenerkrankungen  \" id=\"form-field-field_cf9fe1a-12\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-12\">Schilddr\u00fcsenerkrankungen  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Rheumatische Erkrankungen\" id=\"form-field-field_cf9fe1a-13\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-13\">Rheumatische Erkrankungen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Tumorerkrankungen  \" id=\"form-field-field_cf9fe1a-14\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-14\">Tumorerkrankungen  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Bluterkrankungen\" id=\"form-field-field_cf9fe1a-15\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-15\">Bluterkrankungen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Infektionskrankheiten\" id=\"form-field-field_cf9fe1a-16\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-16\">Infektionskrankheiten<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Psychische Erkrankungen\" id=\"form-field-field_cf9fe1a-17\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-17\">Psychische Erkrankungen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Lungen-\/Bronchialerkrankungen \" id=\"form-field-field_cf9fe1a-18\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-18\">Lungen-\/Bronchialerkrankungen <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Leber -\/Gallenerkrankungen\" id=\"form-field-field_cf9fe1a-19\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-19\">Leber -\/Gallenerkrankungen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Autoimmunerkrankungen\/Allergien  Koronare Herzerkrankung\/Herzinfarkt\" id=\"form-field-field_cf9fe1a-20\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-20\">Autoimmunerkrankungen\/Allergien  Koronare Herzerkrankung\/Herzinfarkt<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sonstige\" id=\"form-field-field_cf9fe1a-21\" name=\"form_fields[field_cf9fe1a][]\"> <label for=\"form-field-field_cf9fe1a-21\">Sonstige<\/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-ana3 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-ana3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBei Sonstige: Welche?\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[ana3]\" id=\"form-field-ana3\" 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_8f9e4d1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_8f9e4d1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAllergien\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=\"Astma\" id=\"form-field-field_8f9e4d1-0\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-0\">Astma<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Hausstaubmilben\" id=\"form-field-field_8f9e4d1-1\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-1\">Hausstaubmilben<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Gr\u00e4serpollen\" id=\"form-field-field_8f9e4d1-2\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-2\">Gr\u00e4serpollen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Bl\u00fctenstaub\" id=\"form-field-field_8f9e4d1-3\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-3\">Bl\u00fctenstaub<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nahrungsmittel\" id=\"form-field-field_8f9e4d1-4\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-4\">Nahrungsmittel<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Tierhaare\" id=\"form-field-field_8f9e4d1-5\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-5\">Tierhaare<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Metalle\" id=\"form-field-field_8f9e4d1-6\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-6\">Metalle<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Aspirin\" id=\"form-field-field_8f9e4d1-7\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-7\">Aspirin<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Antibiotika\" id=\"form-field-field_8f9e4d1-8\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-8\">Antibiotika<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Kontrastmittel\" id=\"form-field-field_8f9e4d1-9\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-9\">Kontrastmittel<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sonstiges z.B. andere Medikamente?\" id=\"form-field-field_8f9e4d1-10\" name=\"form_fields[field_8f9e4d1][]\"> <label for=\"form-field-field_8f9e4d1-10\">Sonstiges z.B. andere Medikamente?<\/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_6f4b526 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6f4b526\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBei Sonstiges: Welche?\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_6f4b526]\" id=\"form-field-field_6f4b526\" 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-acceptance elementor-field-group elementor-column elementor-field-group-field_7c7884a elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7c7884a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tErkrankungen in der Familie?\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_7c7884a]\" id=\"form-field-field_7c7884a\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\">\n\t\t\t\t<label for=\"form-field-field_7c7884a\">Ja, welche?<\/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 elementor-field-group elementor-column elementor-field-group-field_2c21aab 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_2c21aab]\" id=\"form-field-field_2c21aab\" 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-upload elementor-field-group elementor-column elementor-field-group-ana8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-ana8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVorbefunde (bis 4 MB und 5 Dateien - jpg oder pdf)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[ana8][]\" id=\"form-field-ana8\" class=\"elementor-field elementor-size-md  elementor-upload-field\" multiple=\"multiple\" data-maxsize=\"4\" data-maxsize-message=\"This file exceeds the maximum allowed size.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_530ac41 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Best\u00e4tigung \/ Abschluss\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\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-message elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNachricht\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[message]\" id=\"form-field-message\" rows=\"4\" placeholder=\"Hier k\u00f6nnen Sie uns noch eine Nachricht zukommen lassen - bei Executive Check-Up bitte Zusatzleistugen angeben\"><\/textarea>\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-BestatigungFormular 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[BestatigungFormular]\" id=\"form-field-BestatigungFormular\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-BestatigungFormular\">Ich best\u00e4tige, dass ich die unten genannten Hinweise, sowie die <a href=\"\/datenschutz\/\">Datenschutzerkl\u00e4rung<\/a> gelesen und zur Kenntnis genommen habe.\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_a064d94 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_a064d94]\" id=\"form-field-field_a064d94\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_a064d94\">Ich best\u00e4tige, dass ich dar\u00fcber informiert wurde, dass meine Behandlungsunterlagen ausschlie\u00dflich digital \u2013 Ende-zu-Ende verschl\u00fcsselt und DSGVO-konform \u00fcber <a href=\"https:\/\/tresorit.com\/terms-of-use\" target=\"_blank\" rel=\"noopener\">Tresorit<\/a> \u2013 zur Verf\u00fcgung gestellt werden.<\/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-signature elementor-field-group elementor-column elementor-field-group-field_67de121 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_67de121\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tUnterschrift\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class='width-100'><div class='elementor-signature-container' style='width: 400px' ><div class='elementor_signature_clear'><img src='https:\/\/epccheckup.com\/wp-content\/plugins\/signature-field-for-elementor-forms\/lib\/images\/remove-icon.png' alt='' \/><\/div><div class='elementor-signature-field'  data-id=\"field_67de121\" data-background=\"#ffffff\" data-color=\"#000000\" data-width=\"400\" data-height=\"200\" data-name=\"0\" style='width:400px; height: 200px; background: #ffffff'><\/div><\/div>  <input type=\"hidden\" type=\"hidden\" name=\"form_fields[field_67de121]\" id=\"form-field-field_67de121\" class=\"elementor-field elementor-size-md  elementor-upload-field-signature elementor-upload-field-signature-field_67de121\"><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-hidden elementor-field-group elementor-column elementor-field-group-curr_date elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"hidden\" name=\"form_fields[curr_date]\" id=\"form-field-curr_date\" class=\"elementor-field elementor-size-md  elementor-field-textual\" value=\"10 \u6708 21, 2026 11:43 \u4e0b\u5348\">\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-md\" 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\">Senden<\/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-5692ec62 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"5692ec62\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\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<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u4f53\u68c0\u767b\u8bb0\u8868 \u4eb2\u7231\u7684\u5b66\u5458\uff0c\u60a8\u5df2\u51b3\u5b9a\u53c2\u52a0\u6b27\u6d32\u9884\u9632\u4e2d\u5fc3\uff08EPC-GmbH\uff09\u7684\u804c\u4e1a\u5065\u5eb7\u7ba1\u7406\u9879\u76ee\u3002\u60a8\u7684\u96c7\u4e3b\u5df2\u4e0e EPC \u7b7e\u8ba2\u4e86\u5173\u4e8e\u63d0\u4f9b\u9884\u9632\u6027\u533b\u7597\u670d\u52a1\uff08\u4f53\u68c0\uff09\u7684\u6846\u67b6\u534f\u8bae\uff0c\u5e76\u540c\u610f\u652f\u4ed8\u6cbb\u7597\u8d39\u7528\u3002\u60a8\u7684\u96c7\u4e3b\u5c06\u6536\u5230 EPC \u6240\u63d0\u4f9b\u670d\u52a1\u7684\u53d1\u7968\u3002\u8be5\u53d1\u7968\u65e2\u4e0d\u5305\u62ec\u8bca\u65ad\u4e5f\u4e0d\u5305\u62ec\u6570\u5b57\uff0c\u53ea\u5305\u62ec\u60a8\u7684\u59d3\u540d\u3001\u51fa\u751f\u65e5\u671f\u3001\u6cbb\u7597\u65e5\u671f\u548c\u603b\u4ef7\u3002\u8fd9\u6837\u505a\u7684\u76ee\u7684\u662f\u4e3a\u4e86\u4fdd\u62a4\u6570\u636e\u548c\u9075\u5b88\u533b\u7597\u4fdd\u5bc6\u89c4\u5b9a\u3002\u6839\u636e\u8fd9\u5f20\u53d1\u7968\uff0c\u60a8\u7684\u96c7\u4e3b\u53ef\u4ee5\u76f4\u63a5\u5411 EPC \u652f\u4ed8\u8d39\u7528\u3002\u53c2\u52a0\u8005\u58f0\u660e\uff1a\u6211\u540c\u610f\u8fd9\u91cc\u63cf\u8ff0\u7684\u7a0b\u5e8f\u3002\u6211\u8fd8\u7b7e\u5b57\u786e\u8ba4\uff0c\u6211\u5df2\u88ab\u6388\u6743\u4f7f\u7528\u4e0a\u8ff0\u9884\u9632\u6027\u533b\u7597\u670d\u52a1\uff0c\u8d39\u7528\u7531\u6211\u7684\u96c7\u4e3b\u652f\u4ed8\u3002\u6211\u5df2\u63d0\u524d\u6536\u5230\u4e2a\u4eba\u798f\u5229\u6e05\u5355\u3002<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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