{"id":597,"date":"2020-11-03T15:45:17","date_gmt":"2020-11-03T15:45:17","guid":{"rendered":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/?page_id=597"},"modified":"2021-01-08T10:28:19","modified_gmt":"2021-01-08T10:28:19","slug":"register","status":"publish","type":"page","link":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/","title":{"rendered":"Register now"},"content":{"rendered":"<p>To start your treatment at our practice, we ask you to fill in the form below.<\/p>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f629-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"629\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/597\/#wpcf7-f629-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contactformulier\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"629\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"nl_NL\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f629-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<h2>Persoonsgegevens\n<\/h2>\n<p><label> First name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"first-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"first-name\" \/><\/span> <\/label><br \/>\n<span>(Please. mention in children)<\/span>\n<\/p>\n<p><label> Last name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Initials*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"initials\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"initials\" \/><\/span> <\/label>\n<\/p>\n<p><label> Birthday*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"birth-date\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"birth-date\" \/><\/span> <\/label>\n<\/p>\n<p>Gender*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Geslacht\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"Geslacht\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"Geslacht\" value=\"Woman\" \/><span class=\"wpcf7-list-item-label\">Woman<\/span><\/span><\/span><\/span>\n<\/p>\n<h2>Address data\n<\/h2>\n<p><label> Street Name+ House number*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"street-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"street-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Addition<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"street-name-extra\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"street-name-extra\" \/><\/span> <\/label>\n<\/p>\n<p><label> Postal Code*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-postal-code\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-postal-code\" \/><\/span> <\/label>\n<\/p>\n<p><label> Place*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-place\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-place\" \/><\/span> <\/label>\n<\/p>\n<p><label> Phone house*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-phone\" \/><\/span> <\/label>\n<\/p>\n<p><label> Phone work<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-house-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-house-phone\" \/><\/span> <\/label>\n<\/p>\n<p><label> Mobile<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-mobile\" \/><\/span> <\/label>\n<\/p>\n<p><label> E-mail*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label><br \/>\n<span>Enter email address<\/span>\n<\/p>\n<h2>Insurance data\n<\/h2>\n<p>If you visit the practice for the first time, always take your insurance card with you.\n<\/p>\n<p>Insurance name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"menu-849\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"menu-849\"><option value=\"Maak een keuze\">Maak een keuze<\/option><option value=\"Aevitae (ASR) (3328)\">Aevitae (ASR) (3328)<\/option><option value=\"Aevitae (Av\u00e9ro Achmea) (8958)\">Aevitae (Av\u00e9ro Achmea) (8958)<\/option><option value=\"Aevitae (De Goudse) (3330)\">Aevitae (De Goudse) (3330)<\/option><option value=\"Aevitae (VGZ) (8956)\">Aevitae (VGZ) (8956)<\/option><option value=\"Anderzorg (3333)\">Anderzorg (3333)<\/option><option value=\"Av\u00e9ro Achmea (3329)\">Av\u00e9ro Achmea (3329)<\/option><option value=\"Azivo (7054)\">Azivo (7054)<\/option><option value=\"Besured (8995)\">Besured (8995)<\/option><option value=\"BeterDichtbij (3339)\">BeterDichtbij (3339)<\/option><option value=\"Caresco (ASR) (8959)\">Caresco (ASR) (8959)<\/option><option value=\"Caresco (Av\u00e9ro Achmea) (8960)\">Caresco (Av\u00e9ro Achmea) (8960)<\/option><option value=\"Caresco (VGZ) (8965)\">Caresco (VGZ) (8965)<\/option><option value=\"CVZ Vreemdelingen (9990)\">CVZ Vreemdelingen (9990)<\/option><option value=\"CZ (9664)\">CZ (9664)<\/option><option value=\"De Amersfoortse (9018)\">De Amersfoortse (9018)<\/option><option value=\"De Friesland (7084)\">De Friesland (7084)<\/option><option value=\"Delta Lloyd (9664)\">Delta Lloyd (9664)<\/option><option value=\"Ditzo (3336)\">Ditzo (3336)<\/option><option value=\"DSW (7029)\">DSW (7029)<\/option><option value=\"Eno (7032)\">Eno (7032)<\/option><option value=\"FBTO (0211)\">FBTO (0211)<\/option><option value=\"IAK (ASR) (8973)\">IAK (ASR) (8973)<\/option><option value=\"IAK (Avero Achmea) (8971)\">IAK (Avero Achmea) (8971)<\/option><option value=\"IAK (VGZ) (8972)\">IAK (VGZ) (8972)<\/option><option value=\"Interpolis Zorgverzekeringen (3313)\">Interpolis Zorgverzekeringen (3313)<\/option><option value=\"IZA (0699)\">IZA (0699)<\/option><option value=\"IZA-Gemeenten (VNG) (3334)\">IZA-Gemeenten (VNG) (3334)<\/option><option value=\"IZZ (9015)\">IZZ (9015)<\/option><option value=\"Menzis (3332)\">Menzis (3332)<\/option><option value=\"OHRA (9664)\">OHRA (9664)<\/option><option value=\"ONVZ (3343)\">ONVZ (3343)<\/option><option value=\"OWM Stad Holland (7037)\">OWM Stad Holland (7037)<\/option><option value=\"OWM Zorg en Zekerheid (7085)\">OWM Zorg en Zekerheid (7085)<\/option><option value=\"OZF Achmea (3314)\">OZF Achmea (3314)<\/option><option value=\"PNOzorg (ONVZ) (3343)\">PNOzorg (ONVZ) (3343)<\/option><option value=\"Pro Life (9086)\">Pro Life (9086)<\/option><option value=\"Regeling Zorg Asielzoekers (2650)\">Regeling Zorg Asielzoekers (2650)<\/option><option value=\"SZV Krijgsmacht (0212)\">SZV Krijgsmacht (0212)<\/option><option value=\"Turien &amp; Co. (Av\u00e9ro Achmea) (3342)\">Turien &amp; Co. (Av\u00e9ro Achmea) (3342)<\/option><option value=\"Turien &amp; Co. (IZA Cura) (8401)\">Turien &amp; Co. (IZA Cura) (8401)<\/option><option value=\"Turien &amp; Co. (VGZ) (8401)\">Turien &amp; Co. (VGZ) (8401)<\/option><option value=\"Univ\u00e9 Zorg (0101)\">Univ\u00e9 Zorg (0101)<\/option><option value=\"VGZ (7095)\">VGZ (7095)<\/option><option value=\"VPZ (VGZ) (8956)\">VPZ (VGZ) (8956)<\/option><option value=\"VvAA (3343)\">VvAA (3343)<\/option><option value=\"Zilveren Kruis Achmea (3311)\">Zilveren Kruis Achmea (3311)<\/option><option value=\"Zorgverzekeraar UMC (0736)\">Zorgverzekeraar UMC (0736)<\/option><\/select><\/span>\n<\/p>\n<p><label> Polisnumber<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-polis\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-polis\" \/><\/span><\/label>\n<\/p>\n<p><label> Insurance start date<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"date-start-insurance\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-start-insurance\" \/><\/span> <\/label>\n<\/p>\n<p><label> How long ago did you last visit a dentist?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-date-dental\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-date-dental\" \/><\/span> <\/label>\n<\/p>\n<p><label> What are your dental needs?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-759\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-759\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><label> Important information \/ Notes<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"textarea-760\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"textarea-760\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"<p>To start your treatment at our practice, we ask you to fill in the form below.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-597","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Register now - Tandartsenpraktijk Carmenlaan<\/title>\n<meta name=\"description\" content=\"Would you like to register with Tandartsenpraktijk Carmenlaan in Amstelveen? Simply register via our website. We look forward to welcoming you to our practice!\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Register now - Tandartsenpraktijk Carmenlaan\" \/>\n<meta property=\"og:description\" content=\"Would you like to register with Tandartsenpraktijk Carmenlaan in Amstelveen? Simply register via our website. We look forward to welcoming you to our practice!\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/\" \/>\n<meta property=\"og:site_name\" content=\"Tandartsenpraktijk Carmenlaan\" \/>\n<meta property=\"article:modified_time\" content=\"2021-01-08T10:28:19+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/en\\\/register\\\/\",\"url\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/en\\\/register\\\/\",\"name\":\"Register now - Tandartsenpraktijk Carmenlaan\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/#website\"},\"datePublished\":\"2020-11-03T15:45:17+00:00\",\"dateModified\":\"2021-01-08T10:28:19+00:00\",\"description\":\"Would you like to register with Tandartsenpraktijk Carmenlaan in Amstelveen? Simply register via our website. We look forward to welcoming you to our practice!\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/en\\\/register\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/en\\\/register\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/en\\\/register\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/en\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Register now\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/#website\",\"url\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/\",\"name\":\"Tandartsenpraktijk Carmenlaan\",\"description\":\"Mondhygieniste endodontologie esthetische tandheelkunde\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.tandartsenpraktijkcarmenlaan.nl\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Register now - Tandartsenpraktijk Carmenlaan","description":"Would you like to register with Tandartsenpraktijk Carmenlaan in Amstelveen? Simply register via our website. We look forward to welcoming you to our practice!","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/","og_locale":"en_US","og_type":"article","og_title":"Register now - Tandartsenpraktijk Carmenlaan","og_description":"Would you like to register with Tandartsenpraktijk Carmenlaan in Amstelveen? Simply register via our website. We look forward to welcoming you to our practice!","og_url":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/","og_site_name":"Tandartsenpraktijk Carmenlaan","article_modified_time":"2021-01-08T10:28:19+00:00","twitter_card":"summary_large_image","schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/","url":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/","name":"Register now - Tandartsenpraktijk Carmenlaan","isPartOf":{"@id":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/#website"},"datePublished":"2020-11-03T15:45:17+00:00","dateModified":"2021-01-08T10:28:19+00:00","description":"Would you like to register with Tandartsenpraktijk Carmenlaan in Amstelveen? Simply register via our website. We look forward to welcoming you to our practice!","breadcrumb":{"@id":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/register\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/"},{"@type":"ListItem","position":2,"name":"Register now"}]},{"@type":"WebSite","@id":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/#website","url":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/","name":"Tandartsenpraktijk Carmenlaan","description":"Mondhygieniste endodontologie esthetische tandheelkunde","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/wp-json\/wp\/v2\/pages\/597","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/wp-json\/wp\/v2\/comments?post=597"}],"version-history":[{"count":2,"href":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/wp-json\/wp\/v2\/pages\/597\/revisions"}],"predecessor-version":[{"id":630,"href":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/wp-json\/wp\/v2\/pages\/597\/revisions\/630"}],"wp:attachment":[{"href":"https:\/\/www.tandartsenpraktijkcarmenlaan.nl\/en\/wp-json\/wp\/v2\/media?parent=597"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}