Allgemeiner Kontakt zum Arzt

Question

Accepted Answer

<div class='fluentform fluentform_wrapper_3'><form data-form_id="3" id="fluentform_3" class="frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_2 ff-form-loading" data-form_instance="ff_form_instance_3_2" method="POST" >        <span style="display: none !important;"><input type="checkbox"
                name="item__3__fluent_checkme_"
                value="1" style="display:none !important;" tabindex="-1"></span>
        <input type='hidden' name='__fluent_form_embded_post_id' value='3925' /><input type="hidden" id="_fluentform_3_fluentformnonce" name="_fluentform_3_fluentformnonce" value="57715d04db" /><input type="hidden" name="_wp_http_referer" value="/anfragen/" /><div data-type="name-element" data-name="names" class=" ff-field_container ff-name-field-wrapper" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_names_first_name_'>Vorname</label> </div><div class='ff-el-input--content'><input type="text" name="names[first_name]" id="ff_3_names_first_name_" class="ff-el-form-control" tabindex="8" ></div></div></div><div class='ff-t-cell '><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_names_last_name_'>Nachname</label> </div><div class='ff-el-input--content'><input type="text" name="names[last_name]" id="ff_3_names_last_name_" class="ff-el-form-control" tabindex="9" ></div></div></div></div></div><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_email'>Ihre E-Mail Adresse</label> </div><div class='ff-el-input--content'><input type="email" name="email" id="ff_3_email" class="ff-el-form-control" data-name="email" tabindex="10" ></div></div><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_numeric-field'>Ihre Rückrufnummer</label> </div><div class='ff-el-input--content'><input type="number" name="numeric-field" id="ff_3_numeric-field" class="ff-el-form-control" data-name="numeric-field" inputmode="numeric" step="any" tabindex="11" ></div></div><div class='ff-el-group'><div class='ff-el-input--label ff-el-is-required asterisk-right'><label for='ff_3_message'>Ihre Nachricht / Anfrage</label> </div><div class='ff-el-input--content'><textarea name="message" id="ff_3_message" class="ff-el-form-control" rows="4" cols="2" data-name="message" tabindex="12" ></textarea></div></div><div data-name="ff_cn_id_1"  class='ff-t-container ff-column-container ff_columns_total_1  '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 100%;'><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label class='ff-el-form-check-label ff_tc_label' for=gdpr-agreement_9976f8dbcb72b83dd5ea4ec222d354bb><span class='ff_tc_checkbox'><input type="checkbox" name="gdpr-agreement" class="ff-el-form-check-input ff_gdpr_field" data-name="gdpr-agreement" id="gdpr-agreement_9976f8dbcb72b83dd5ea4ec222d354bb" tabindex="13"  value='on'></span> <div class='ff_t_c'>Ich stimme zu, dass die von mir übermittelten Informationen gespeichert werden, damit meine Anfrage beantwortet werden kann</div></label></div></div></div></div><div class='ff-el-group ' ><div class='ff-el-input--content'><div data-fluent_id='3' name='h-captcha-response'><div
		data-sitekey='1d1ff6e2-6551-4374-aa69-62c59a036f3a'
		id='fluentform-hcaptcha-3'
		class='ff-el-hcaptcha h-captcha'></div></div></div></div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type="submit" class="ff-btn ff-btn-submit ff-btn-md ff_btn_style" tabindex="14" >Anfrage jetzt absenden!</button></div></form><div id='fluentform_3_errors' class='ff-errors-in-stack ff_form_instance_3_2 ff-form-loading_errors ff_form_instance_3_2_errors'></div></div>        <script type="text/javascript">
            window.fluent_form_ff_form_instance_3_2 = {"id":"3","settings":{"layout":{"labelPlacement":"top","helpMessagePlacement":"with_label","errorMessagePlacement":"inline","asteriskPlacement":"asterisk-right"},"id":"39","restrictions":{"denyEmptySubmission":{"enabled":false}}},"form_instance":"ff_form_instance_3_2","form_id_selector":"fluentform_3","rules":{"names[first_name]":{"required":{"value":true,"message":"Dieses Feld ist erforderlich!"}},"names[middle_name]":{"required":{"value":false,"message":"This field is required"}},"names[last_name]":{"required":{"value":true,"message":"Dieses Feld ist erforderlich!"}},"email":{"required":{"value":true,"message":"Dieses Feld ist erforderlich!"},"email":{"value":true,"message":"This field must contain a valid email"}},"numeric-field":{"required":{"value":true,"message":"Dieses Feld ist erforderlich"},"numeric":{"value":true,"message":"Dieses Feld muss numerische Werte enthalten"},"min":{"value":"","message":"Mindestwert ist "},"max":{"value":"","message":"Maximalwert ist "}},"message":{"required":{"value":true,"message":"Dieses Feld ist erforderlich"}},"gdpr-agreement":{"required":{"value":true,"message":"Dieses Feld ist erforderlich!"}}}};
                    </script>

Allgemeine Anfragen

Willkommen

Anfahrt & Kontakt

Leistungen

Netzwerk