{"id":2465,"date":"2023-02-03T12:07:56","date_gmt":"2023-02-03T10:07:56","guid":{"rendered":"https:\/\/www.kardiologie-saalkreis.de\/?page_id=2465"},"modified":"2023-08-14T13:55:47","modified_gmt":"2023-08-14T11:55:47","slug":"temp-psychokardiologie-fragebogen","status":"publish","type":"page","link":"https:\/\/www.kardiologie-saalkreis.de\/?page_id=2465","title":{"rendered":"Fragebogen Psychologie"},"content":{"rendered":"\n<p><\/p>\n\n\n\n<div style=\"display:none\" class=\"fm-form-container fm-theme80\"><div id=\"fm-pages34\" class=\"fm-pages wdform_page_navigation \" show_title=\"\" show_numbers=\"1\" type=\"none\"><\/div><form name=\"form34\" action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F2465\" method=\"post\" id=\"form34\" class=\"fm-form form34  \" enctype=\"multipart\/form-data\"><input type=\"hidden\" id=\"fm_page_id34\" value=\"2465\" name=\"fm_page_id34\" \/><input type=\"hidden\" id=\"fm_current_post_type34\" value=\"page\" name=\"fm_current_post_type34\" \/><input type=\"hidden\" id=\"counter34\" value=\"53\" name=\"counter34\" \/><input type=\"hidden\" id=\"Itemid34\" value=\"\" name=\"Itemid34\" \/><input type=\"hidden\" id=\"fm_shake34\" value=\"1\" name=\"fm_shake34\" \/><input type=\"text\" class=\"fm-hide\" id=\"fm_empty_field_validation34\" value=\"\" name=\"fm_empty_field_validation34\" data-value=\"bd736efb144d599cf463541431fbf5c4\" \/><div class=\"fm-header-bg\"><div class=\"fm-header \"><div class=\"fm-header-text\">          <div class=\"fm-header-title\">            Fragebogen Psychologie          <\/div>          <div class=\"fm-header-description\">                      <\/div>        <\/div><\/div><\/div><div class=\"wdform-page-and-images fm-form-builder\"><div id=\"34form_view1\" class=\"wdform_page\" page_title=\"Untitled page\" next_title=\"Next\" next_type=\"text\" next_class=\"wdform-page-button\" next_checkable=\"true\" previous_title=\"Previous\" previous_type=\"text\" previous_class=\"wdform-page-button\" previous_checkable=\"false\"><div class=\"wdform_section\"><div class=\"wdform_column\"><div wdid=\"37\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Ich bin bereits Patientin bzw. Patient in Ihrer Praxis<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_37_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_37_element340\" name=\"wdform_37_element34\" value=\"Ja\" onclick=\"set_default(&quot;wdform_37&quot;,&quot;0&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_37_element340\"><span><\/span>Ja<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_37_element341\" name=\"wdform_37_element34\" value=\"Nein\" onclick=\"set_default(&quot;wdform_37&quot;,&quot;1&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_37_element341\"><span><\/span>Nein<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"2\" class=\"wdform_row\"><div type=\"type_name\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_name\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_2_element_first34\" class=\"wdform-label\">Ihr Vorname und Name<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_2_element_first34\" name=\"wdform_2_element_first34\" data-value=\"\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_2_element_first34\">Vorname<\/label><\/div><div class=\"wd-flex wd-flex-column wd-name-separator\"><\/div><div class=\"wd-flex wd-flex-column wd-width-50\"><input type=\"text\" class=\"wd-width-100\" id=\"wdform_2_element_last34\" name=\"wdform_2_element_last34\" data-value=\"\" value=\"\" title=\"\" placeholder=\"\"  \/><label class=\"mini_label\" for=\"wdform_2_element_last34\">Nachname<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"3\" class=\"wdform_row\"><div type=\"type_date_fields\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_date_fields\" ><div class=\"wdform-label-section wd-width-100 wdform_date_fields wd-flex-row\">    <label  for=\"wdform_3_day34\" class=\"wdform-label\">Ihr Geburtsdatum<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex wdform_date_fields wd-flex-row wd-width-100\" ><div class=\"wd-flex wd-flex-row wd-width-100 wd-align-items\"><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_3_day34\" name=\"wdform_3_day34\" class=\"wdform_select_day\" style=\"width: 60px;\" ><option value=\"\"><\/option><option value=\"01\" >01<\/option><option value=\"02\" >02<\/option><option value=\"03\" >03<\/option><option value=\"04\" >04<\/option><option value=\"05\" >05<\/option><option value=\"06\" >06<\/option><option value=\"07\" >07<\/option><option value=\"08\" >08<\/option><option value=\"09\" >09<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><label for=\"wdform_3_day34\" class=\"mini_label\">Tag<\/label><\/div><span class=\"wdform_separator\">&nbsp;\/&nbsp;<\/span><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_3_month34\" name=\"wdform_3_month34\" class=\"wdform_select_month\" style=\"width: 100px;\" ><option value=\"\"><\/option><option value=\"01\"   >Januar<\/option><option value=\"02\" >Februar<\/option><option value=\"03\" >M\u00e4rz<\/option><option value=\"04\"  >April<\/option><option value=\"05\"  >Mai<\/option><option value=\"06\"  >Juni<\/option><option value=\"07\"  >Juli<\/option><option value=\"08\"  >August<\/option><option value=\"09\"  >September<\/option><option value=\"10\"  >Oktober<\/option><option value=\"11\" >November<\/option><option value=\"12\"  >Dezember<\/option><\/select><label for=\"wdform_3_month34\" class=\"mini_label\">Monat<\/label><\/div><span class=\"wdform_separator\">&nbsp;\/&nbsp;<\/span><div class=\"wd-flex wd-flex-column\"><select id=\"wdform_3_year34\" name=\"wdform_3_year34\"  from=\"1901\" to=\"2022\" class=\"wdform_select_year\" style=\"width: 80px;\" ><option value=\"\"><\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><\/select><label for=\"wdform_3_year34\" class=\"mini_label\">Jahr<\/label><\/div><\/div><\/div><\/div><\/div><div wdid=\"5\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_5_element34\" class=\"wdform-label\">Ihre Telefonnummer<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 200px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_5_element34\"                           name=\"wdform_5_element34\"                           value=\"\"                           data-value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"6\" class=\"wdform_row\"><div type=\"type_submitter_mail\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_submitter_mail\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row\">    <label  for=\"wdform_6_element34\" class=\"wdform-label\">Ihre Email-Adresse<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-width-100\" ><input type=\"text\" class=\"wd-width-100\" id=\"wdform_6_element34\" name=\"wdform_6_element34\" data-value=\"\" value=\"\" title=\"\" placeholder=\"\"   onchange=\"wd_check_email('6', '34', 'Dies ist keine g\u00fcltige E-Mail-Adresse.')\" \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"14\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_14_element34\" class=\"wdform-label\">PLZ<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" style=\"max-width: 100px;\"><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_14_element34\"                           name=\"wdform_14_element34\"                           value=\"\"                           data-value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"15\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_15_element34\" class=\"wdform-label\">Ort<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_15_element34\"                           name=\"wdform_15_element34\"                           value=\"\"                           data-value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"16\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_16_element34\" class=\"wdform-label\">Stra\u00dfe<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_16_element34\"                           name=\"wdform_16_element34\"                           value=\"\"                           data-value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"50\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Ich bin ...<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_50_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_50_element340\" name=\"wdform_50_element34\" value=\"gesetzlich versichert\" onclick=\"set_default(&quot;wdform_50&quot;,&quot;0&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_50_element340\"><span><\/span>gesetzlich versichert<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_50_element341\" name=\"wdform_50_element34\" value=\"privat versichert\" onclick=\"set_default(&quot;wdform_50&quot;,&quot;1&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_50_element341\"><span><\/span>privat versichert<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"52\" class=\"wdform_row\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_52_element34\" class=\"wdform-label\">Ihre Krankenkasse<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_52_element34\"                           name=\"wdform_52_element34\"                           value=\"\"                           data-value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"7\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_text\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_text\" ><div class=\"wdform-label-section wd-width-100  wd-flex-row wd-align-items-center\">    <label  for=\"wdform_7_element34\" class=\"wdform-label\">ausge\u00fcbter Beruf<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-row wd-align-items-center wd-width-100\" ><input type=\"text\"                           class=\"wd-width-100\"                           id=\"wdform_7_element34\"                           name=\"wdform_7_element34\"                           value=\"\"                           data-value=\"\"                           title=\"\"                           placeholder=\"\"                                                       \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"8\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_8_element34\" class=\"wdform-label\">Beschreiben Sie kurz Ihre Symptomatik, unter der Sie leiden:<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_8_element34\"                      name=\"wdform_8_element34\"                      placeholder=\"\"                      data-value=\"\"                      maxlength=\"\"                      style=\"height: 200px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"41\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Wie  stark belastet f\u00fchlen Sie sich durch die Symptomatik, unter der sie leiden?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_41_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_41_element340\" name=\"wdform_41_element34\" value=\"stark\" onclick=\"set_default(&quot;wdform_41&quot;,&quot;0&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_41_element340\"><span><\/span>stark<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_41_element341\" name=\"wdform_41_element34\" value=\"mittelm\u00e4\u00dfig\" onclick=\"set_default(&quot;wdform_41&quot;,&quot;1&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_41_element341\"><span><\/span>mittelm\u00e4\u00dfig<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_41_element342\" name=\"wdform_41_element34\" value=\"kaum\" onclick=\"set_default(&quot;wdform_41&quot;,&quot;2&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_41_element342\"><span><\/span>kaum<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"51\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Wie  stark belastet f\u00fchlen Sie sich durch die Symptomatik, unter der sie leiden?(1)<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_51_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_51_element340\" name=\"wdform_51_element34\" value=\"stark\" onclick=\"set_default(&quot;wdform_51&quot;,&quot;0&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_51_element340\"><span><\/span>stark<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_51_element341\" name=\"wdform_51_element34\" value=\"mittelm\u00e4\u00dfig\" onclick=\"set_default(&quot;wdform_51&quot;,&quot;1&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_51_element341\"><span><\/span>mittelm\u00e4\u00dfig<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_51_element342\" name=\"wdform_51_element34\" value=\"kaum\" onclick=\"set_default(&quot;wdform_51&quot;,&quot;2&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_51_element342\"><span><\/span>kaum<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"42\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Leiden Sie unter einer Reduktion Ihrer Lebensfreude seit dem Beginn der Symptomatik?<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_42_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_42_element340\" name=\"wdform_42_element34\" value=\"stark\" onclick=\"set_default(&quot;wdform_42&quot;,&quot;0&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_42_element340\"><span><\/span>stark<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_42_element341\" name=\"wdform_42_element34\" value=\"mittelm\u00e4\u00dfig\" onclick=\"set_default(&quot;wdform_42&quot;,&quot;1&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_42_element341\"><span><\/span>mittelm\u00e4\u00dfig<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_42_element342\" name=\"wdform_42_element34\" value=\"kaum\" onclick=\"set_default(&quot;wdform_42&quot;,&quot;2&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_42_element342\"><span><\/span>kaum<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"43\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Leiden Sie verst\u00e4rkt unter \u00c4ngsten seit Beginn der Symptomatik? <\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_43_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_43_element340\" name=\"wdform_43_element34\" value=\"stark\" onclick=\"set_default(&quot;wdform_43&quot;,&quot;0&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_43_element340\"><span><\/span>stark<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_43_element341\" name=\"wdform_43_element34\" value=\"mittelm\u00e4\u00dfig\" onclick=\"set_default(&quot;wdform_43&quot;,&quot;1&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_43_element341\"><span><\/span>mittelm\u00e4\u00dfig<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_43_element342\" name=\"wdform_43_element34\" value=\"kaum\" onclick=\"set_default(&quot;wdform_43&quot;,&quot;2&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_43_element342\"><span><\/span>kaum<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"44\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Zeigen Sie aufgrund der Symptome Vermeidungsverhalten? <\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_44_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_44_element340\" name=\"wdform_44_element34\" value=\"stark\" onclick=\"set_default(&quot;wdform_44&quot;,&quot;0&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_44_element340\"><span><\/span>stark<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_44_element341\" name=\"wdform_44_element34\" value=\"mittelm\u00e4\u00dfig\" onclick=\"set_default(&quot;wdform_44&quot;,&quot;1&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_44_element341\"><span><\/span>mittelm\u00e4\u00dfig<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_44_element342\" name=\"wdform_44_element34\" value=\"kaum\" onclick=\"set_default(&quot;wdform_44&quot;,&quot;2&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_44_element342\"><span><\/span>kaum<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"45\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Kommt es durch die Symptomatik zu Einschr\u00e4nkungen im pers\u00f6nlichen, sozialen oder beruflichen Bereich - oder ganz allgemein im Bereich Ihrer Lebensf\u00fchrung? <\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_45_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_45_element340\" name=\"wdform_45_element34\" value=\"stark\" onclick=\"set_default(&quot;wdform_45&quot;,&quot;0&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_45_element340\"><span><\/span>stark<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_45_element341\" name=\"wdform_45_element34\" value=\"mittelm\u00e4\u00dfig\" onclick=\"set_default(&quot;wdform_45&quot;,&quot;1&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_45_element341\"><span><\/span>mittelm\u00e4\u00dfig<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_45_element342\" name=\"wdform_45_element34\" value=\"kaum\" onclick=\"set_default(&quot;wdform_45&quot;,&quot;2&quot;,&quot;34&quot;); \"   \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_45_element342\"><span><\/span>kaum<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"46\" class=\"wdform_row\"><div type=\"type_radio\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_radio\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Sind Sie derzeit in psychotherapeutischer Behandlung oder planen Sie diese?  Hinweis: Warteliste bedeutet, dass Sie bereits auf einer W. stehen.<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_46_element34\" value=\"\" \/><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_46_element340\" name=\"wdform_46_element34\" value=\"ja\" onclick=\"set_default(&quot;wdform_46&quot;,&quot;0&quot;,&quot;34&quot;); \"   attribute=value \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_46_element340\"><span><\/span>ja<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_46_element341\" name=\"wdform_46_element34\" value=\"nein\" onclick=\"set_default(&quot;wdform_46&quot;,&quot;1&quot;,&quot;34&quot;); \"   attribute=value \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_46_element341\"><span><\/span>nein<\/label><\/div><div class=\"radio-div wd-choice wd-flex wd-flex-row\"><input type=\"radio\"  id=\"wdform_46_element342\" name=\"wdform_46_element34\" value=\"Warteliste\" onclick=\"set_default(&quot;wdform_46&quot;,&quot;2&quot;,&quot;34&quot;); \"   attribute=value \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_46_element342\"><span><\/span>Warteliste<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"32\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_32_element34\" class=\"wdform-label\">Gibt es sonst wichtige Bemerkungen\/Informationen, die f\u00fcr die Behandlung aus Ihrer Sicht von Bedeutung sind?<\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_32_element34\"                      name=\"wdform_32_element34\"                      placeholder=\"\"                      data-value=\"\"                      maxlength=\"\"                      style=\"height: 200px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"47\" class=\"wdform_row\"><div type=\"type_textarea\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_textarea\" ><div class=\"wdform-label-section wd-width-100 \">    <label  for=\"wdform_47_element34\" class=\"wdform-label\">Anmerkung der behandelnden \u00c4rztin\/des behandelnden Arztes: <\/label><\/div><div class=\"wdform-element-section wd-flex  wd-width-100\" ><textarea class=\"wd-width-100\"                      id=\"wdform_47_element34\"                      name=\"wdform_47_element34\"                      placeholder=\"\"                      data-value=\"\"                      maxlength=\"\"                      style=\"height: 200px;\"                      ><\/textarea><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"11\" class=\"wdform_row\" style=\"position: relative; left: 0px; top: 0px;\"><div type=\"type_checkbox\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_checkbox\" ><div class=\"wdform-label-section wd-width-100  wd-flex-wrap wd-flex-column\">    <label  class=\"wdform-label\">Ich habe die Hinweise zum Datenschutz gelesen und bin mit der Speicherung und Verarbeitung meiner pers\u00f6nlichen Daten zum Zweck der Bearbeitung meines Terminwunsches einverstanden.<\/label><span class=\"wdform-required\">*<\/span><\/div><div class=\"wdform-element-section wd-flex  wd-flex-wrap wd-flex-column wd-width-100\" ><div class=\"wd-flex wd-flex-column\"><input type=\"hidden\" name=\"wdform_11_element34\" value=\"\" \/><div class=\"checkbox-div wd-choice wd-flex wd-flex-row\"><input type=\"checkbox\"  id=\"wdform_11_element340\" name=\"wdform_11_element340\" value=\"Zustimmung\"    \/><label class=\"wd-align-items-center wd-flex wd-flex-row\" for=\"wdform_11_element340\"><span><\/span>Zustimmung<\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"48\" class=\"wdform_row\"><div type=\"type_hidden\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_hidden\" ><div class=\"wdform-element-section wd-flex wd-width-100\" ><input type=\"hidden\" data-value=\"34\" value=\"34\" id=\"wdform_48_element34\" name=\"form_id\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"49\" class=\"wdform_row\"><div type=\"type_hidden\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_hidden\" ><div class=\"wdform-element-section wd-flex wd-width-100\" ><input type=\"hidden\" data-value=\"1\" value=\"1\" id=\"wdform_49_element34\" name=\"localTransfer\"  \/><\/div><\/div><\/div><\/div><div class=\"wdform_column\"><div wdid=\"1\" class=\"wdform_row\"><div type=\"type_submit_reset\" class=\"wdform-field wd-width-100 wd-flex wd-flex-column fm-type_submit_reset\" ><div class=\"wdform-element-section wd-flex  wd-flex-row wd-justify-content-right wd-width-100\" ><button  type=\"button\" class=\"button-submit\" onclick=\"fm_submit_form('34');\"  data-ajax=\"0\"><span class=\"fm-submit-loading spinner fm-ico-spinner\"><\/span>Absenden<\/button><button  type=\"button\" class=\"button-reset wd-hidden\" onclick=\"fm_reset_form(34);\" >Reset<\/button><\/div><\/div><\/div><\/div><\/div><div valign=\"top\" class=\"wdform_footer wd-width-100\"><div class=\"wd-width-100\"><div class=\"wd-width-100 wd-table\" style=\"padding-top:10px;\"><div class=\"wd-table-group\"><div id=\"34page_nav1\" class=\"wd-table-row\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"wdform_preload\"><\/div><input type=\"hidden\" name=\"fm-current-page\" value=\"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F2465\" \/><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=\/wp\/v2\/pages\/2465"}],"collection":[{"href":"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2465"}],"version-history":[{"count":9,"href":"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=\/wp\/v2\/pages\/2465\/revisions"}],"predecessor-version":[{"id":2609,"href":"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=\/wp\/v2\/pages\/2465\/revisions\/2609"}],"wp:attachment":[{"href":"https:\/\/www.kardiologie-saalkreis.de\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2465"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}