{"id":4164,"date":"2022-11-02T12:27:13","date_gmt":"2022-11-02T12:27:13","guid":{"rendered":"https:\/\/heinofolmer.com\/registration-share-data\/"},"modified":"2024-03-04T12:10:59","modified_gmt":"2024-03-04T12:10:59","slug":"registration-share-data","status":"publish","type":"page","link":"https:\/\/heinofolmer.com\/en\/registration-share-data\/","title":{"rendered":"Register\/change data"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"4164\" class=\"elementor elementor-4164 elementor-2730\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-099617f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"099617f\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-eccd1b4\" data-id=\"eccd1b4\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c07a91f elementor-widget elementor-widget-spacer\" data-id=\"c07a91f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\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<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-504fc42 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"504fc42\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-88d7e63\" data-id=\"88d7e63\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1e253f4 elementor-widget elementor-widget-text-editor\" data-id=\"1e253f4\" 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><span style=\"font-weight: 400;\">You can register by telephone<\/span> or <b>at the counter<\/b><span style=\"font-weight: 400;\"> with the assistant who will supervise your registration. If necessary, the assistant will make an appointment with you to meet the doctor.<\/span><\/p>\n<\/p>\n<p><b>You can register online using the form below:<\/b><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-883b6d2 elementor-hidden-mobile\" data-id=\"883b6d2\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-691be28 elementor-widget elementor-widget-image\" data-id=\"691be28\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"720\" height=\"481\" src=\"https:\/\/heinofolmer.com\/wp-content\/uploads\/2023\/02\/inschrijven-gegevens-wijzigen.jpg\" class=\"attachment-full size-full wp-image-4015\" alt=\"\" srcset=\"https:\/\/heinofolmer.com\/wp-content\/uploads\/2023\/02\/inschrijven-gegevens-wijzigen.jpg 720w, https:\/\/heinofolmer.com\/wp-content\/uploads\/2023\/02\/inschrijven-gegevens-wijzigen-300x200.jpg 300w\" sizes=\"(max-width: 720px) 100vw, 720px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0660c43 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0660c43\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-6cc2f0f\" data-id=\"6cc2f0f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2d4cb59 elementor-widget elementor-widget-heading\" data-id=\"2d4cb59\" 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<span class=\"elementor-heading-title elementor-size-default\">* = Required field<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1ba9720 raven-form-button-align-left elementor-widget elementor-widget-raven-form\" data-id=\"1ba9720\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"inschrijven\" data-settings=\"{&quot;fields&quot;:[{&quot;label&quot;:&quot;Full Name&quot;,&quot;_id&quot;:&quot;2c969c5&quot;,&quot;acceptance_text&quot;:null,&quot;required&quot;:&quot;true&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:0,&quot;field_custom_id&quot;:&quot;2c969c5&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Date of birth&quot;,&quot;acceptance_text&quot;:null,&quot;required&quot;:&quot;true&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;a7f8949&quot;,&quot;index&quot;:1,&quot;native_html5&quot;:null,&quot;field_custom_id&quot;:&quot;a7f8949&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;f9edd56&quot;,&quot;label&quot;:&quot;Address (residential address)&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:2,&quot;field_custom_id&quot;:&quot;f9edd56&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Residential address (if different from home address)&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;f092d55&quot;,&quot;index&quot;:3,&quot;field_custom_id&quot;:&quot;f092d55&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;type&quot;:&quot;tel&quot;,&quot;label&quot;:&quot;Telephone number&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;f3da91f&quot;,&quot;required&quot;:&quot;true&quot;,&quot;index&quot;:4,&quot;field_custom_id&quot;:&quot;f3da91f&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;iti_tel&quot;:&quot;&quot;,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;74610b4&quot;,&quot;type&quot;:&quot;email&quot;,&quot;label&quot;:&quot;Email address&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;required&quot;:&quot;true&quot;,&quot;index&quot;:5,&quot;field_custom_id&quot;:&quot;74610b4&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;ce9fa1e&quot;,&quot;label&quot;:&quot;NIF number (Portuguese tax number; if resident)&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:6,&quot;field_custom_id&quot;:&quot;ce9fa1e&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;3ee0c1e&quot;,&quot;label&quot;:&quot;N\\u00famero de utente (Portuguese health insurance number, SNS; if resident)&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:7,&quot;field_custom_id&quot;:&quot;3ee0c1e&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Or name of health insurance company and identification number of EHIC card&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;079ec79&quot;,&quot;index&quot;:8,&quot;field_custom_id&quot;:&quot;079ec79&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;222080f&quot;,&quot;type&quot;:&quot;radio&quot;,&quot;label&quot;:&quot;Sign in only&quot;,&quot;acceptance_text&quot;:null,&quot;field_options&quot;:&quot;Register only\\nRegister with an appointment&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:9,&quot;field_custom_id&quot;:&quot;222080f&quot;,&quot;placeholder&quot;:null,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;inline_list&quot;:&quot;&quot;,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:null},{&quot;label&quot;:&quot;Reason for appointment (to meet \\\/ otherwise):&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;2538d63&quot;,&quot;index&quot;:10,&quot;field_custom_id&quot;:&quot;2538d63&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;f28ac57&quot;,&quot;type&quot;:&quot;radio&quot;,&quot;label&quot;:&quot;Medical file&quot;,&quot;acceptance_text&quot;:null,&quot;field_options&quot;:&quot;Without medical record\\nMedical record will be provided later\\nUpload medical record or other medical data&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:11,&quot;field_custom_id&quot;:&quot;f28ac57&quot;,&quot;placeholder&quot;:null,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;inline_list&quot;:&quot;&quot;,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:null},{&quot;_id&quot;:&quot;d6af12c&quot;,&quot;type&quot;:&quot;file&quot;,&quot;acceptance_text&quot;:null,&quot;allow_multiple_upload&quot;:&quot;true&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;field_custom_id&quot;:&quot;d6af12c&quot;,&quot;label&quot;:&quot;&quot;,&quot;placeholder&quot;:null,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:&quot;&quot;,&quot;file_types&quot;:&quot;&quot;,&quot;max_files&quot;:&quot;&quot;,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:null},{&quot;type&quot;:&quot;textarea&quot;,&quot;label&quot;:&quot;Explanation&quot;,&quot;acceptance_text&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;46f9514&quot;,&quot;index&quot;:13,&quot;field_custom_id&quot;:&quot;46f9514&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:5,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;}],&quot;steps_type&quot;:&quot;number&quot;,&quot;steps_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"raven-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"raven-form raven-flex raven-flex-wrap raven-flex-bottom\" method=\"post\" name=\"Making an appointment\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"4164\" \/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"1ba9720\" \/>\n\t\t\t\t\t<div id=\"raven-field-group-2c969c5\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100 raven-field-required\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-2c969c5\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tFull Name\t\t\t\t\t\t\t<span class=\"required-mark-label\"><\/span>\n\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[2c969c5]\" id=\"form-field-2c969c5\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"2c969c5\" required=\"required\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-a7f8949\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100 raven-field-required\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-a7f8949\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tDate of birth\t\t\t\t\t\t\t<span class=\"required-mark-label\"><\/span>\n\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[a7f8949]\" id=\"form-field-a7f8949\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"a7f8949\" required=\"required\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-f9edd56\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-f9edd56\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tAddress (residential address)\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[f9edd56]\" id=\"form-field-f9edd56\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"f9edd56\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-f092d55\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-f092d55\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tResidential address (if different from home address)\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[f092d55]\" id=\"form-field-f092d55\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"f092d55\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-f3da91f\" class=\"raven-flex-wrap raven-field-type-tel raven-field-group elementor-column elementor-col-100 raven-field-required\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-f3da91f\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tTelephone number\t\t\t\t\t\t\t<span class=\"required-mark-label\"><\/span>\n\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"tel\" name=\"fields[f3da91f]\" id=\"form-field-f3da91f\" class=\"raven-field\" placeholder=\"\" data-type=\"tel\" data-custom-id=\"f3da91f\" required=\"required\" pattern=\"^[0-9\\-\\+\\s\\(\\)]*$\" title=\"The value should only consist numbers and phone characters (-, +, (), etc)\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-74610b4\" class=\"raven-flex-wrap raven-field-type-email raven-field-group elementor-column elementor-col-100 raven-field-required\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-74610b4\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tEmail address\t\t\t\t\t\t\t<span class=\"required-mark-label\"><\/span>\n\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"email\" name=\"fields[74610b4]\" id=\"form-field-74610b4\" class=\"raven-field\" placeholder=\"\" data-type=\"email\" data-custom-id=\"74610b4\" required=\"required\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-ce9fa1e\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-ce9fa1e\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tNIF number (Portuguese tax number; if resident)\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[ce9fa1e]\" id=\"form-field-ce9fa1e\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"ce9fa1e\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-3ee0c1e\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-3ee0c1e\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tN\u00famero de utente (Portuguese health insurance number, SNS; if resident)\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[3ee0c1e]\" id=\"form-field-3ee0c1e\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"3ee0c1e\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-079ec79\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-079ec79\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tOr name of health insurance company and identification number of EHIC card\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[079ec79]\" id=\"form-field-079ec79\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"079ec79\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-222080f\" class=\"raven-flex-wrap raven-field-type-radio raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-222080f\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tSign in only\t\t\t\t\t\t<\/label>\n\t\t<div class=\"raven-field-subgroup \"><span class=\"raven-field-option\"><input type=\"radio\" value=\"Register only\" id=\"form-field-222080f-0-b769\" name=\"fields[222080f][]\" data-custom-id=\"222080f\"  class=\"raven-field\"> <label for=\"form-field-222080f-0-b769\" class=\"raven-field-label raven-field-option-label\">Register only<\/label><\/span><span class=\"raven-field-option\"><input type=\"radio\" value=\"Register with an appointment\" id=\"form-field-222080f-1-b769\" name=\"fields[222080f][]\" data-custom-id=\"222080f\"  class=\"raven-field\"> <label for=\"form-field-222080f-1-b769\" class=\"raven-field-label raven-field-option-label\">Register with an appointment<\/label><\/span><\/div>\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-2538d63\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-2538d63\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tReason for appointment (to meet \/ otherwise):\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[2538d63]\" id=\"form-field-2538d63\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"2538d63\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-f28ac57\" class=\"raven-flex-wrap raven-field-type-radio raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-f28ac57\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tMedical file\t\t\t\t\t\t<\/label>\n\t\t<div class=\"raven-field-subgroup \"><span class=\"raven-field-option\"><input type=\"radio\" value=\"Without medical record\" id=\"form-field-f28ac57-0-n9z9\" name=\"fields[f28ac57][]\" data-custom-id=\"f28ac57\"  class=\"raven-field\"> <label for=\"form-field-f28ac57-0-n9z9\" class=\"raven-field-label raven-field-option-label\">Without medical record<\/label><\/span><span class=\"raven-field-option\"><input type=\"radio\" value=\"Medical record will be provided later\" id=\"form-field-f28ac57-1-n9z9\" name=\"fields[f28ac57][]\" data-custom-id=\"f28ac57\"  class=\"raven-field\"> <label for=\"form-field-f28ac57-1-n9z9\" class=\"raven-field-label raven-field-option-label\">Medical record will be provided later<\/label><\/span><span class=\"raven-field-option\"><input type=\"radio\" value=\"Upload medical record or other medical data\" id=\"form-field-f28ac57-2-n9z9\" name=\"fields[f28ac57][]\" data-custom-id=\"f28ac57\"  class=\"raven-field\"> <label for=\"form-field-f28ac57-2-n9z9\" class=\"raven-field-label raven-field-option-label\">Upload medical record or other medical data<\/label><\/span><\/div>\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-d6af12c\" class=\"raven-flex-wrap raven-field-type-file raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<div class=\"raven-field-subgroup \">\n\t\t\t<span class=\"raven-field-option\">\n\t\t\t\t<input\n\t\t\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\t\t\ttype=\"file\"\n\t\t\t\t\ttype=\"file\" id=\"form-field-d6af12c\" class=\"raven-field\" placeholder=\"\" data-type=\"file\" data-custom-id=\"d6af12c\" multiple=\"multiple\" name=\"fields[d6af12c][]\"\t\t\t\t>\n\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-46f9514\" class=\"raven-flex-wrap raven-field-type-textarea raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-46f9514\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tExplanation\t\t\t\t\t\t<\/label>\n\t\t\t\t<textarea\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"textarea\" name=\"fields[46f9514]\" id=\"form-field-46f9514\" class=\"raven-field\" placeholder=\"\" data-type=\"textarea\" data-custom-id=\"46f9514\"\t\t\trows=\"5\"><\/textarea>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"raven-field-group raven-field-type-submit-button elementor-column elementor-col-66\">\n\t\t\t\t\t\t\t\t\t<button class=\"raven-submit-button\" type=\"submit\">\n\t\t\t\t\t\t<span>Send<\/span>\n\t\t<\/button>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/form>\n\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a8b4ee9 elementor-widget elementor-widget-text-editor\" data-id=\"a8b4ee9\" 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><i>We find your privacy of the utmost importance, so the form below will be sent fully secured and will only be seen by the assistant(s) and the doctor. <\/i><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-42a61fe elementor-hidden-mobile\" data-id=\"42a61fe\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-0cd231e elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"0cd231e\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-8fa6228\" data-id=\"8fa6228\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9592f82 elementor-widget elementor-widget-spacer\" data-id=\"9592f82\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\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-43bbdab elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"43bbdab\" 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-1fa8339 elementor-widget elementor-widget-spacer\" data-id=\"1fa8339\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\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<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-82d9064 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"82d9064\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-e8848a8\" data-id=\"e8848a8\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3621a8b elementor-widget elementor-widget-heading\" data-id=\"3621a8b\" 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\">Change data<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8d24f4a elementor-widget elementor-widget-text-editor\" data-id=\"8d24f4a\" 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><b>If important data have changed, you can use this form to inform us<\/b><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2334edb elementor-widget elementor-widget-heading\" data-id=\"2334edb\" 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<span class=\"elementor-heading-title elementor-size-default\">* = Required field<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b91f180 raven-form-button-align-left elementor-widget elementor-widget-raven-form\" data-id=\"b91f180\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;fields&quot;:[{&quot;label&quot;:&quot;Full Name&quot;,&quot;_id&quot;:&quot;2c969c5&quot;,&quot;acceptance_text&quot;:null,&quot;required&quot;:&quot;true&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:0,&quot;field_custom_id&quot;:&quot;2c969c5&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Date of birth&quot;,&quot;acceptance_text&quot;:null,&quot;required&quot;:&quot;true&quot;,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;type&quot;:&quot;date&quot;,&quot;_id&quot;:&quot;a7f8949&quot;,&quot;index&quot;:1,&quot;field_custom_id&quot;:&quot;a7f8949&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:&quot;&quot;,&quot;max_date&quot;:&quot;&quot;,&quot;localization&quot;:&quot;&quot;,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:&quot;&quot;,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;f9edd56&quot;,&quot;label&quot;:&quot;Address (in country of residence)&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:2,&quot;field_custom_id&quot;:&quot;f9edd56&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Residential address (if different from home address)&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;f092d55&quot;,&quot;index&quot;:3,&quot;field_custom_id&quot;:&quot;f092d55&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;type&quot;:&quot;tel&quot;,&quot;label&quot;:&quot;Telephone number&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;f3da91f&quot;,&quot;index&quot;:4,&quot;field_custom_id&quot;:&quot;f3da91f&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;74610b4&quot;,&quot;type&quot;:&quot;email&quot;,&quot;label&quot;:&quot;Email address&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:5,&quot;field_custom_id&quot;:&quot;74610b4&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;ce9fa1e&quot;,&quot;label&quot;:&quot;NIF number (Portuguese tax number; if resident)&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:6,&quot;field_custom_id&quot;:&quot;ce9fa1e&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;_id&quot;:&quot;3ee0c1e&quot;,&quot;label&quot;:&quot;N\\u00famero de utente (Portuguese health insurance number, SNS; if resident)&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;index&quot;:7,&quot;field_custom_id&quot;:&quot;3ee0c1e&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;},{&quot;label&quot;:&quot;Or name of health insurance company and identification number of EHIC card&quot;,&quot;acceptance_text&quot;:null,&quot;step_previous_button&quot;:null,&quot;step_next_button&quot;:null,&quot;_id&quot;:&quot;079ec79&quot;,&quot;index&quot;:8,&quot;field_custom_id&quot;:&quot;079ec79&quot;,&quot;type&quot;:&quot;text&quot;,&quot;placeholder&quot;:&quot;&quot;,&quot;recaptcha_badge&quot;:null,&quot;recaptcha_theme&quot;:null,&quot;recaptcha_size&quot;:null,&quot;checked_by_default&quot;:null,&quot;min_time&quot;:null,&quot;max_time&quot;:null,&quot;min_date&quot;:null,&quot;max_date&quot;:null,&quot;localization&quot;:null,&quot;min&quot;:null,&quot;max&quot;:null,&quot;field_options&quot;:null,&quot;inline_list&quot;:null,&quot;field_html&quot;:null,&quot;native_html5&quot;:null,&quot;multiple_selection&quot;:null,&quot;rows&quot;:null,&quot;required&quot;:&quot;&quot;,&quot;iti_tel&quot;:null,&quot;iti_tel_tel_type&quot;:null,&quot;iti_tel_require_area&quot;:null,&quot;iti_tel_allow_dropdown&quot;:null,&quot;iti_tel_country_include&quot;:null,&quot;iti_tel_ip_detect&quot;:null,&quot;iti_tel_internationalize&quot;:null,&quot;file_sizes&quot;:null,&quot;file_types&quot;:null,&quot;allow_multiple_upload&quot;:null,&quot;max_files&quot;:null,&quot;step_icon&quot;:null,&quot;width&quot;:&quot;100&quot;,&quot;width_tablet&quot;:&quot;&quot;,&quot;width_mobile&quot;:&quot;&quot;,&quot;field_value&quot;:&quot;&quot;}],&quot;steps_type&quot;:&quot;number&quot;,&quot;steps_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"raven-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"raven-form raven-flex raven-flex-wrap raven-flex-bottom\" method=\"post\" name=\"Making an appointment\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"4164\" \/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"b91f180\" \/>\n\t\t\t\t\t<div id=\"raven-field-group-2c969c5\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100 raven-field-required\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-2c969c5\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tFull Name\t\t\t\t\t\t\t<span class=\"required-mark-label\"><\/span>\n\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[2c969c5]\" id=\"form-field-2c969c5\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"2c969c5\" required=\"required\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-a7f8949\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100 raven-field-required\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-a7f8949\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tDate of birth\t\t\t\t\t\t\t<span class=\"required-mark-label\"><\/span>\n\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[a7f8949]\" id=\"form-field-a7f8949\" class=\"raven-field flatpickr\" placeholder=\"\" data-type=\"date\" data-custom-id=\"a7f8949\" required=\"required\"\t\t\tdata-min-date=\"\"\t\t\t\t\t\tdata-max-date=\"\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-f9edd56\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-f9edd56\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tAddress (in country of residence)\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[f9edd56]\" id=\"form-field-f9edd56\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"f9edd56\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-f092d55\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-f092d55\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tResidential address (if different from home address)\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[f092d55]\" id=\"form-field-f092d55\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"f092d55\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-f3da91f\" class=\"raven-flex-wrap raven-field-type-tel raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-f3da91f\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tTelephone number\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"tel\" name=\"fields[f3da91f]\" id=\"form-field-f3da91f\" class=\"raven-field\" placeholder=\"\" data-type=\"tel\" data-custom-id=\"f3da91f\" pattern=\"^[0-9\\-\\+\\s\\(\\)]*$\" title=\"The value should only consist numbers and phone characters (-, +, (), etc)\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-74610b4\" class=\"raven-flex-wrap raven-field-type-email raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-74610b4\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tEmail address\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"email\" name=\"fields[74610b4]\" id=\"form-field-74610b4\" class=\"raven-field\" placeholder=\"\" data-type=\"email\" data-custom-id=\"74610b4\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-ce9fa1e\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-ce9fa1e\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tNIF number (Portuguese tax number; if resident)\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[ce9fa1e]\" id=\"form-field-ce9fa1e\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"ce9fa1e\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-3ee0c1e\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-3ee0c1e\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tN\u00famero de utente (Portuguese health insurance number, SNS; if resident)\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[3ee0c1e]\" id=\"form-field-3ee0c1e\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"3ee0c1e\">\n\t\t\t\t<\/div>\n\t\t\t\t<div id=\"raven-field-group-079ec79\" class=\"raven-flex-wrap raven-field-type-text raven-field-group elementor-column elementor-col-100\">\n\t\t\t\t\t<label\n\t\t\tfor=\"form-field-079ec79\"\n\t\t\tclass=\"raven-field-label\">\n\t\t\tOr name of health insurance company and identification number of EHIC card\t\t\t\t\t\t<\/label>\n\t\t\t\t<input\n\t\t\toninput=\"onInvalidRavenFormField(event)\"\n\t\t\toninvalid=\"onInvalidRavenFormField(event)\"\n\t\t\ttype=\"text\" name=\"fields[079ec79]\" id=\"form-field-079ec79\" class=\"raven-field\" placeholder=\"\" data-type=\"text\" data-custom-id=\"079ec79\">\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"raven-field-group raven-field-type-submit-button elementor-column elementor-col-66\">\n\t\t\t\t\t\t\t\t\t<button class=\"raven-submit-button\" type=\"submit\">\n\t\t\t\t\t\t<span>Send<\/span>\n\t\t<\/button>\n\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/form>\n\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d2a111c elementor-widget elementor-widget-text-editor\" data-id=\"d2a111c\" 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><i>We find your privacy of the utmost importance, so the form below will be sent fully secured and will only be seen by the assistant(s) and the doctor. <\/i><\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-431fe85 elementor-hidden-mobile\" data-id=\"431fe85\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-02dea9a elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"02dea9a\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-332cd2b\" data-id=\"332cd2b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-3cb4b21 elementor-widget elementor-widget-spacer\" data-id=\"3cb4b21\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\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<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>You can register by telephone or at the counter with the assistant who will supervise your registration. If necessary, the assistant will make an appointment with you to meet the doctor. You can register online using the form below: * = Required field Full Name Date of birth Address (residential address) Residential address (if different [&hellip;]<\/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,"footnotes":""},"class_list":["post-4164","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Register\/change data - Huisartsenpraktijk Heino Folmer<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/heinofolmer.com\/inschrijven-gegevens-delen\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Register\/change data - Huisartsenpraktijk Heino Folmer\" \/>\n<meta property=\"og:description\" content=\"You can register by telephone or at the counter with the assistant who will supervise your registration. 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