{"id":98,"date":"2025-05-30T15:30:55","date_gmt":"2025-05-30T15:30:55","guid":{"rendered":"https:\/\/woo.rodeboei.eu\/?page_id=98"},"modified":"2025-10-08T17:56:35","modified_gmt":"2025-10-08T15:56:35","slug":"bestelformulier","status":"publish","type":"page","link":"https:\/\/woo.rodeboei.eu\/index.php\/bestelformulier\/","title":{"rendered":"Bestelformulier"},"content":{"rendered":"<script>\n\/\/----------------------------------------------------------\n\/\/------ JAVASCRIPT HOOK FUNCTIONS FOR GRAVITY FORMS -------\n\/\/----------------------------------------------------------\n\nif ( ! gform ) {\n\tdocument.addEventListener( 'gform_main_scripts_loaded', function() { gform.scriptsLoaded = true; } );\n\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', function() { gform.themeScriptsLoaded = true; } );\n\twindow.addEventListener( 'DOMContentLoaded', function() { gform.domLoaded = true; } );\n\n\tvar gform = {\n\t\tdomLoaded: false,\n\t\tscriptsLoaded: false,\n\t\tthemeScriptsLoaded: false,\n\t\tisFormEditor: () => typeof InitializeEditor === 'function',\n\n\t\t\/**\n\t\t * @deprecated 2.9 the use of initializeOnLoaded in the form editor context is deprecated.\n\t\t * @remove-in 4.0 this function will not check for gform.isFormEditor().\n\t\t *\/\n\t\tcallIfLoaded: function ( fn ) {\n\t\t\tif ( gform.domLoaded && gform.scriptsLoaded && ( gform.themeScriptsLoaded || gform.isFormEditor() ) ) {\n\t\t\t\tif ( gform.isFormEditor() ) {\n\t\t\t\t\tconsole.warn( 'The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.' );\n\t\t\t\t}\n\t\t\t\tfn();\n\t\t\t\treturn true;\n\t\t\t}\n\t\t\treturn false;\n\t\t},\n\n\t\t\/**\n\t\t * Call a function when all scripts are loaded\n\t\t *\n\t\t * @param function fn the callback function to call when all scripts are loaded\n\t\t *\n\t\t * @returns void\n\t\t *\/\n\t\tinitializeOnLoaded: function( fn ) {\n\t\t\tif ( ! gform.callIfLoaded( fn ) ) {\n\t\t\t\tdocument.addEventListener( 'gform_main_scripts_loaded', () => { gform.scriptsLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', () => { gform.themeScriptsLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t\twindow.addEventListener( 'DOMContentLoaded', () => { gform.domLoaded = true; gform.callIfLoaded( fn ); } );\n\t\t\t}\n\t\t},\n\n\t\thooks: { action: {}, filter: {} },\n\t\taddAction: function( action, callable, priority, tag ) {\n\t\t\tgform.addHook( 'action', action, callable, priority, tag );\n\t\t},\n\t\taddFilter: function( action, callable, priority, tag ) {\n\t\t\tgform.addHook( 'filter', action, callable, priority, tag );\n\t\t},\n\t\tdoAction: function( action ) {\n\t\t\tgform.doHook( 'action', action, arguments );\n\t\t},\n\t\tapplyFilters: function( action ) {\n\t\t\treturn gform.doHook( 'filter', action, arguments );\n\t\t},\n\t\tremoveAction: function( action, tag ) {\n\t\t\tgform.removeHook( 'action', action, tag );\n\t\t},\n\t\tremoveFilter: function( action, priority, tag ) {\n\t\t\tgform.removeHook( 'filter', action, priority, tag );\n\t\t},\n\t\taddHook: function( hookType, action, callable, priority, tag ) {\n\t\t\tif ( undefined == gform.hooks[hookType][action] ) {\n\t\t\t\tgform.hooks[hookType][action] = [];\n\t\t\t}\n\t\t\tvar hooks = gform.hooks[hookType][action];\n\t\t\tif ( undefined == tag ) {\n\t\t\t\ttag = action + '_' + hooks.length;\n\t\t\t}\n\t\t\tif( priority == undefined ){\n\t\t\t\tpriority = 10;\n\t\t\t}\n\n\t\t\tgform.hooks[hookType][action].push( { tag:tag, callable:callable, priority:priority } );\n\t\t},\n\t\tdoHook: function( hookType, action, args ) {\n\n\t\t\t\/\/ splice args from object into array and remove first index which is the hook name\n\t\t\targs = Array.prototype.slice.call(args, 1);\n\n\t\t\tif ( undefined != gform.hooks[hookType][action] ) {\n\t\t\t\tvar hooks = gform.hooks[hookType][action], hook;\n\t\t\t\t\/\/sort by priority\n\t\t\t\thooks.sort(function(a,b){return a[\"priority\"]-b[\"priority\"]});\n\n\t\t\t\thooks.forEach( function( hookItem ) {\n\t\t\t\t\thook = hookItem.callable;\n\n\t\t\t\t\tif(typeof hook != 'function')\n\t\t\t\t\t\thook = window[hook];\n\t\t\t\t\tif ( 'action' == hookType ) {\n\t\t\t\t\t\thook.apply(null, args);\n\t\t\t\t\t} else {\n\t\t\t\t\t\targs[0] = hook.apply(null, args);\n\t\t\t\t\t}\n\t\t\t\t} );\n\t\t\t}\n\t\t\tif ( 'filter'==hookType ) {\n\t\t\t\treturn args[0];\n\t\t\t}\n\t\t},\n\t\tremoveHook: function( hookType, action, priority, tag ) {\n\t\t\tif ( undefined != gform.hooks[hookType][action] ) {\n\t\t\t\tvar hooks = gform.hooks[hookType][action];\n\t\t\t\thooks = hooks.filter( function(hook, index, arr) {\n\t\t\t\t\tvar removeHook = (undefined==tag||tag==hook.tag) && (undefined==priority||priority==hook.priority);\n\t\t\t\t\treturn !removeHook;\n\t\t\t\t} );\n\t\t\t\tgform.hooks[hookType][action] = hooks;\n\t\t\t}\n\t\t}\n\t};\n}\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_12' style='display:none'><style>#gform_wrapper_12[data-form-index=\"0\"].gform-theme,[data-parent-form=\"12_0\"]{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: 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12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-sm);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-sm);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-sm);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-sm);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_12' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Bestelformulier 1 (1)<\/h2>\n                            <p class='gform_description'>Bestelformulier eigen netwerk en overige thuiszorgen<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/index.php\/wp-json\/wp\/v2\/pages\/98#gf_12' data-formid='12' novalidate><input id=\"gpnf_session_hash_12\" type=\"hidden\" name=\"gpnf_session_hash\" value=\"9d9a806ecb76\">\n        <div id='gf_progressbar_wrapper_12' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Stap <span class='gf_step_current_page'>1<\/span> van <span class='gf_step_page_count'>5<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_20' style='width:20%;'><span>20%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_12_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_12_72\" class=\"gfield gfield--type-image_choice gfield--type-choice gfield--image-choice-appearance-card gfield--image-choice-style-square gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Ik kies  voor:<\/legend><div class='ginput_container ginput_container_radio ginput_container_image_choice ginput_container_image_choice--label-show ginput_container_image_choice--input-show'><div class=\"gfield_radio\" id=\"input_12_72\"><div class='gchoice gchoice_12_72_0'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='21,15'  id='choice_12_72_0' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_12_72_0\"\/>\n\t\t\t\t\t<label for='choice_12_72_0' id='label_12_72_0' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\tBasisalarm\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_12_72_1'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='23,70'  id='choice_12_72_1' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_12_72_1\"\/>\n\t\t\t\t\t<label for='choice_12_72_1' id='label_12_72_1' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\tBasisalarm Zeker\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_12_72_2'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='26,20'  id='choice_12_72_2' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_12_72_2\"\/>\n\t\t\t\t\t<label for='choice_12_72_2' id='label_12_72_2' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\tBasisalarm GSM\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><div class='gchoice gchoice_12_72_3'>\n\t\t\t<span class='gfield-image-choice-wrapper-outer'>\n\t\t\t\t<div class=\"gfield-choice-image-wrapper\"><\/div>\n\t\t\t\t<span class='gfield-image-choice-wrapper-inner'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='24,95'  id='choice_12_72_3' onchange='gformToggleRadioOther( this )'   aria-describedby=\"gchoice_image_12_72_3\"\/>\n\t\t\t\t\t<label for='choice_12_72_3' id='label_12_72_3' class='gform-field-label gform-field-label--type-inline'>\n\t\t\t\t\t\tUitthuisalarm\n\t\t\t\t\t<\/label>\n\t\t\t\t<\/span>\n\t\t\t\t\n\t\t\t<\/span>\n\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >1. Uw gegevens (gegevens gebruiker alarm)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_12_1'>\n                            \n                            <span id='input_12_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_12_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_1_3' class='gform-field-label gform-field-label--type-sub '>Voorletter(s)<\/label>\n                                                <\/span>\n                            <span id='input_12_1_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.4' id='input_12_1_4' value=''   aria-required='false'     \/>\n                                                    <label for='input_12_1_4' class='gform-field-label gform-field-label--type-sub '>Tussenvoegsel<\/label>\n                                                <\/span>\n                            <span id='input_12_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_12_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_1_6' class='gform-field-label gform-field-label--type-sub '>Achternaam<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_12_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Geslacht<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_3'>\n\t\t\t<div class='gchoice gchoice_12_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Man'  id='choice_12_3_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_3_0' id='label_12_3_0' class='gform-field-label gform-field-label--type-inline'>Man<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Vrouw'  id='choice_12_3_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_3_1' id='label_12_3_1' class='gform-field-label gform-field-label--type-inline'>Vrouw<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_4\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_4'>Uw geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_4' id='input_12_4' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_12_4_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_12_4_date_format' class='screen-reader-text'>DD dash MM dash JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_12_4' class='gform_hidden' value='https:\/\/woo.rodeboei.eu\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_12_5\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Adres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_12_5' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_12_5_1_container' >\n                                        <label for='input_12_5_1' id='input_12_5_1_label' class='gform-field-label gform-field-label--type-sub '>Straat en huisnummer<\/label>\n                                        <input type='text' name='input_5.1' id='input_12_5_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_12_5_3_container' >\n                                    <label for='input_12_5_3' id='input_12_5_3_label' class='gform-field-label gform-field-label--type-sub '>Woonplaats<\/label>\n                                    <input type='text' name='input_5.3' id='input_12_5_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_5.4' id='input_12_5_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_12_5_5_container' >\n                                    <label for='input_12_5_5' id='input_12_5_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                    <input type='text' name='input_5.5' id='input_12_5_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_5.6' id='input_12_5_6' value='Nederland' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_12_6\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_6'>E-mailadres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_6' id='input_12_6' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_12_6\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_12_6'>Dit mag uw emailadres zijn, maar mag ook van uw contactpersoon zijn<\/div><\/div><div id=\"field_12_7\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_7'>Uw telefoonummer (vast of mobiel)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_7' id='input_12_7' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_8\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_8'>Uw tweede telefoonnummer (vast of mobiel)<\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_12_8' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_12_16\" class=\"gfield gfield--type-product gfield--type-choice gfield--input-type-radio gfield--width-full gfield_price gfield_price_12_16 gfield_product_12_16 gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >2. Wie gaat uw alarm installeren<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_16'>\n\t\t\t<div class='gchoice gchoice_12_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='De monteur van RSVO-alamering|75'  id='choice_12_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_16_0' id='label_12_16_0' class='gform-field-label gform-field-label--type-inline'>De monteur van RSVO-alamering<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Mijn contactpersoon of ik zelf|30'  id='choice_12_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_16_1' id='label_12_16_1' class='gform-field-label gform-field-label--type-inline'>Mijn contactpersoon of ik zelf<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_12_42' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende '  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_2' class='gform_page' data-js='page-field-id-42' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_12_13\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>3. Prijzen: abonnement en eenmalig (inclusief 21% btw)<\/h3><\/div><fieldset id=\"field_12_83\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Activatiekosten Uit en Thuisalarm<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_83'><div class='gchoice gchoice_12_83_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_83.1' type='checkbox'  value='25' checked='checked' id='choice_12_83_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_83_1' id='label_12_83_1' class='gform-field-label gform-field-label--type-inline'>Activatiekosten<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_17\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_calculation field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_17'>Eenmalige kosten<\/label><div class='ginput_container ginput_container_number'><input name='input_17' id='input_12_17' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\" aria-describedby=\"gfield_description_12_17\" \/><\/div><div class='gfield_description' id='gfield_description_12_17'>Als wij aansluitmateriaal moeten leveren berekenen wij dit aan u.<\/div><\/div><div id=\"field_12_15\" class=\"gfield gfield--type-product gfield--input-type-calculation gfield--width-full gfield_price gfield_price_12_15 gfield_product_12_15 gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' for='input_12_15_1'>Maandelijks kosten<\/label><div class='ginput_container ginput_container_product_calculation'>\n\t\t\t\t\t<input type='hidden' name='input_15.1' value='Maandelijks kosten' class='gform_hidden' \/>\n\t\t\t\t\t<div id='ginput_product_price_12_15' class='ginput_product_price_wrapper'>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price_label'>Prijs:<\/span>\n\t\t\t\t\t\t<span class='gform-field-label gform-field-label--type-sub-large ginput_product_price' id='input_12_15'>\u20ac 25,00<\/span>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<input type='hidden' name='input_15.2' id='ginput_base_price_12_15' class='gform_hidden ginput_calculated_price' value='\u20ac 25,00'\/>\n\t\t\t\t\t<input type='hidden' name='input_15.3' value='1' class='ginput_quantity_12_15 gform_hidden' \/>\n\t\t\t\t<\/div><\/div><fieldset id=\"field_12_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Heeft u een internetmodem in de woonkamer staan waarop het Persoonsalarm kan worden aangesloten:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_12_18'>\n\t\t\t<div class='gchoice gchoice_12_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='ja'  id='choice_12_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_18_0' id='label_12_18_0' class='gform-field-label gform-field-label--type-inline'>ja<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_12_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='nee: kies een ander type alarm'  id='choice_12_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_12_18_1' id='label_12_18_1' class='gform-field-label gform-field-label--type-inline'>nee: kies een ander type alarm<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_78\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>\nU hebt gekozen voor een alarm dat bedraad word aangesloten op het internetmodem in de woonkamer. Als er geen internetmodem in de woonkamer aanwezig is kunt u kiezen voor het Basisalarm GSM of het Uit en Thuisalarm.\n<\/p>\n<\/div><fieldset id=\"field_12_76\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Extra&#039;s (eenmalig)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_76'><div class='gchoice gchoice_12_76_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_76.1' type='checkbox'  value='75'  id='choice_12_76_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_76_1' id='label_12_76_1' class='gform-field-label gform-field-label--type-inline'>Spoedinstallatie door monteur binnen 1 werkdag<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_20\" class=\"gfield gfield--type-option gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_price gfield_price_12_15 gfield_option_12_15 field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Extra&#039;s (maandelijks)<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_20'><div class='gchoice gchoice_12_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Tweede alarmknop (voor partner) extra|3.55'  id='choice_12_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_1' id='label_12_20_1' class='gform-field-label gform-field-label--type-inline'>Tweede alarmknop (voor partner) extra<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_80\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Geen titel<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_80'><div class='gchoice gchoice_12_80_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_80.1' type='checkbox'  value='3,55'  id='choice_12_80_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_80_1' id='label_12_80_1' class='gform-field-label gform-field-label--type-inline'>Luxe zender \u20ac 3,55<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_79\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Geen titel<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_79'><div class='gchoice gchoice_12_79_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_79.1' type='checkbox'  value='12,50'  id='choice_12_79_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_79_1' id='label_12_79_1' class='gform-field-label gform-field-label--type-inline'>Alarmknop met valdetectie extra (in plaats van standaard alarmknop) \u20ac 12,50<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_77\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Geen titel<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_77'><div class='gchoice gchoice_12_77_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_77.1' type='checkbox'  value='4,05 \u20ac'  id='choice_12_77_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_77_1' id='label_12_77_1' class='gform-field-label gform-field-label--type-inline'>Welzijnsmeldingen \u20ac 4,05<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_82\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Geen titel<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_82'><div class='gchoice gchoice_12_82_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_82.1' type='checkbox'  value='3,55 \u20ac'  id='choice_12_82_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_82_1' id='label_12_82_1' class='gform-field-label gform-field-label--type-inline'>Extra zender voor thuis \u20ac 3,55<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_12_21\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_21'>Totaal maandelijks kosten<\/label><div class='ginput_container ginput_container_number'><input name='input_21' id='input_12_21' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_12_22\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_22'>Totaal eenmalig kosten<\/label><div class='ginput_container ginput_container_number'><input name='input_22' id='input_12_22' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_12_24\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >4. Heeft u een geschikt alarm gekozen?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_24'><div class='gchoice gchoice_12_24_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.1' type='checkbox'  value='ik kan mijn alarmknop indrukken bij nood en bedenk ook dat ik dat bij nood moet doen'  id='choice_12_24_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_24_1' id='label_12_24_1' class='gform-field-label gform-field-label--type-inline'>ik kan mijn alarmknop indrukken bij nood en bedenk ook dat ik dat bij nood moet doen<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_75\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heeft u een geschikt alarm gekozen?<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_75'><div class='gchoice gchoice_12_75_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_75.1' type='checkbox'  value='Ik kan zelf mijn alarm (dagelijks) opladen'  id='choice_12_75_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_75_1' id='label_12_75_1' class='gform-field-label gform-field-label--type-inline'>Ik kan zelf mijn alarm (dagelijks) opladen<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_12_43' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Vorige'  \/> <input type='button' id='gform_next_button_12_43' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_3' class='gform_page' data-js='page-field-id-43' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_12_25\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>5. Hulpverleners<\/h3>\nVoeg hier minimaal 2 hulpverleners toe<\/div><div id=\"field_12_84\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_84'>Aantal hulpverleners<\/label><div class='ginput_container ginput_container_number'><input name='input_84' id='input_12_84' type='number' step='any'   value='2' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_12_70\" class=\"gfield gfield--type-form gfield--input-type-form gform-theme__no-reset--children gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_70'>Hulpverleners<\/label><div class=\"gpnf-nested-entries-container ginput_container\">\n\n\t<table class=\"gpnf-nested-entries\">\n\n\t\t<thead>\n\t\t<tr>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-row_id\">\n\t\t\t\t\tRow ID\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-1\">\n\t\t\t\t\tNaam\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-14\">\n\t\t\t\t\tNaam Thuiszorg organisatie\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-7\">\n\t\t\t\t\tSoort hulpverlener\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-18\">\n\t\t\t\t\tAls\t\t\t\t<\/th>\n\t\t\t\t\t\t\t<th class=\"gpnf-field-15\">\n\t\t\t\t\tContactpersoon opties\t\t\t\t<\/th>\n\t\t\t\t\t\t<th class=\"gpnf-row-actions\"><span class=\"screen-reader-text\">Actions<\/span><\/th>\n\t\t<\/tr>\n\t\t<\/thead>\n\n\t\t<tbody data-bind=\"visible: entries().length, foreach: entries\">\n\t\t<tr data-bind=\"attr: { 'data-entryid': id }\">\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: frow_id.label, attr: { 'data-value': frow_id.label }\"\n\t\t\t\t\tdata-heading=\"Row ID\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f1.label, attr: { 'data-value': f1.label }\"\n\t\t\t\t\tdata-heading=\"Naam\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f14.label, attr: { 'data-value': f14.label }\"\n\t\t\t\t\tdata-heading=\"Naam Thuiszorg organisatie\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f7.label, attr: { 'data-value': f7.label }\"\n\t\t\t\t\tdata-heading=\"Soort hulpverlener\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f18.label, attr: { 'data-value': f18.label }\"\n\t\t\t\t\tdata-heading=\"Als\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t\t<td class=\"gpnf-field\"\n\t\t\t\t\tdata-bind=\"html: f15.label, attr: { 'data-value': f15.label }\"\n\t\t\t\t\tdata-heading=\"Contactpersoon opties\"\n\t\t\t\t>&nbsp;<\/td>\n\t\t\t\t\t\t<td class=\"gpnf-row-actions\" style=\"display: none;\" data-bind=\"visible: true\">\n\t\t\t\t<ul>\n\t\t\t\t\t<li class=\"edit\"><button type=\"button\" class=\"edit-button gform-theme-button--secondary\" data-bind=\"click: $parent.editEntry, attr: { 'aria-label': 'Edit hulpverlener {0} where Row ID is {1}.'.gformFormat( $index() + 1, frow_id.label ) }\">Edit<\/button><\/li>\n\t\t\t\t\t\t\t\t\t\t<li class=\"delete\"><button type=\"button\" class=\"delete-button gform-theme-button--simple gform-theme-button--size-md\" data-bind=\"click: $parent.deleteEntry, attr: { 'aria-label': 'Delete hulpverlener {0} where Row ID is {1}.'.gformFormat( $index() + 1, frow_id.label ) }\">Delete<\/button><\/li>\n\t\t\t\t<\/ul>\n\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t\t<tbody data-bind=\"visible: entries().length <= 0\">\n\t\t<tr class=\"gpnf-no-entries\" data-bind=\"visible: entries().length <= 0\" style=\"display: none;\">\n\t\t\t<td colspan=\"7\">\n\t\t\t\tThere are no <span>hulpverleners.<\/span>\t\t\t<\/td>\n\t\t<\/tr>\n\t\t<\/tbody>\n\n\t<\/table>\n\n\t<button type=\"button\" class=\"gpnf-add-entry\"\n\t\t        data-formid=\"12\"\n\t\t        data-nestedformid=\"10\"\n\t\t\t\tdata-bind=\"attr: { disabled: isMaxed }, css: { 'gf-default-disabled': isMaxed }\"\n\t\t\t\t>\n\t\t\t\tAdd hulpverlener\n\t\t\t<\/button>\t\n\t\t\t<p class=\"gpnf-add-entry-max\" data-bind=\"visible: isMaxed\" style=\"display: none;\">\n\t\t\t\tMaximum number of hulpverleners reached.\n\t\t\t<\/p>\n<\/div>\n<input type=\"hidden\"\n                name=\"input_70\"\n                id=\"input_12_70\"\n                data-bind=\"value: entryIds\"\n                value=\"\" \/><\/div><div id=\"field_12_95\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_95'>Regelzaken<\/label><div class='ginput_container ginput_container_text'><input name='input_95' id='input_12_95' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_96\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Dit veld is verborgen bij het bekijken van het formulier\"><\/i><span>Dit veld is verborgen bij het bekijken van het formulier<\/span><\/div><label class='gfield_label gform-field-label' for='input_12_96'>Installatieafspraak<\/label><div class='ginput_container ginput_container_text'><input name='input_96' id='input_12_96' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_36\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>6. Contactpersoon voor maken van installatieafspraak<\/h3>\n\n<script>\ndocument.addEventListener('gpnf_postRender', function(event, formId, fieldId, gpnfField){\n  \/\/ Nested Form veld ID in parent (pas dit aan)\n  if(fieldId === 70){\n\n    \/\/ Haal alle child entries op\n    var entries = gpnfField.viewModel.entries();\n\n    \/\/ Flags die we in de hidden fields gaan zetten\n    var hasREGEL = false;\n    var hasINSTAL = false;\n\n    \/\/ Loop door alle child entries\n    entries.forEach(function(entry){\n      \/\/ Checkboxvelden in child zijn arrays van waarden\n      var regeField = entry.field_values[14.1]; \/\/ child field ID 3\n      var instField  = entry.field_values[14.2]; \/\/ child field ID 4\n\n      if(regeField && regeField.length > 0){\n        hasREGEL = true;\n      }\n      if(bigField && bigField.length > 0){\n        hasINSTAL = true;\n      }\n    });\n\n    \/\/ Schrijf naar parent hidden fields\n    var regeInput = document.querySelector('#input_' + formId + '_25');\n    if(regeInput){\n      regeInput.value = hasREGEL ? 'Ja' : 'Nee';\n      regeInput.dispatchEvent(new Event('change'));\n    }\n\n    var instInput = document.querySelector('#input_' + formId + '_26');\n    if(instInput){\n      instInput.value = hasINSTAL ? 'Ja' : 'Nee';\n      instInput.dispatchEvent(new Event('change'));\n    }\n  }\n});\n<\/script>\n<\/div><div id=\"field_12_40\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_40'>Maak een keuze:<\/label><div class='ginput_container ginput_container_select'><select name='input_40' id='input_12_40' class='large gfield_select'     aria-invalid=\"false\" ><option value='client zelf' >client zelf<\/option><option value='zelf invullen' >zelf invullen<\/option><\/select><\/div><\/div><fieldset id=\"field_12_37\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_37'>\n                            \n                            <span id='input_12_37_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_37.3' id='input_12_37_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_37_3' class='gform-field-label gform-field-label--type-sub '>Voorletter(s)<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_37_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_37.6' id='input_12_37_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_37_6' class='gform-field-label gform-field-label--type-sub '>Achternaam<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_12_38\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_38'>Telefoonnummer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_38' id='input_12_38' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_12_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Vorige'  \/> <input type='button' id='gform_next_button_12_44' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_4' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_12_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>7. Contactpersoon voor regelzaken (vereist)<\/h3><\/div><div id=\"field_12_74\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_74'>Maak een keuze:<\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_12_74' class='large gfield_select'     aria-invalid=\"false\" ><option value='Contactpersoon voor Installatieafspraak' >Contactpersoon voor Installatieafspraak<\/option><option value='Zelf invullen' >Zelf invullen<\/option><\/select><\/div><\/div><fieldset id=\"field_12_45\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_12_45'>\n                            \n                            <span id='input_12_45_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.3' id='input_12_45_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_45_3' class='gform-field-label gform-field-label--type-sub '>Voornaam<\/label>\n                                                <\/span>\n                            \n                            <span id='input_12_45_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_45.6' id='input_12_45_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_12_45_6' class='gform-field-label gform-field-label--type-sub '>Achternaam<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_12_39\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_39'>Telefoonnummer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_39' id='input_12_39' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_47\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_47'>Telefoonummer 2<\/label><div class='ginput_container ginput_container_phone'><input name='input_47' id='input_12_47' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_12_47\"  \/><\/div><div class='gfield_description' id='gfield_description_12_47'>(niet verplicht)<\/div><\/div><div id=\"field_12_52\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_52'>Uw relatie tot deze contactpersoon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_52' id='input_12_52' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_48\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>8. Toegang tot uw woning<\/h3>\n\nNa een alarmoproep moeten hulpverleners bij u binnen kunnen komen in uw woning. Dat kan betekenen dat ze ook in de centrale toegangsdeur moeten kunnen. <b> Uw alarm kan pas ge\u00efnstalleerd worden als minimaal twee hulpverleners of de medewerkers van de Thuiszorg toegang tot uw (gebouw en) woning hebben.<\/b><\/div><fieldset id=\"field_12_55\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Toegang tot (uw gebouw) en woning voor thuiszorgen:<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_55'><div class='gchoice gchoice_12_55_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_55.1' type='checkbox'  value='ik regel de toegang tot mijn woning met deze thuiszorg en laat het RSVO-alarmering weten als de thuiszorg naar binnen kan'  id='choice_12_55_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_55_1' id='label_12_55_1' class='gform-field-label gform-field-label--type-inline'>ik regel de toegang tot mijn woning met deze thuiszorg en laat het RSVO-alarmering weten als de thuiszorg naar binnen kan<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_12_56\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Toegang tot uw (gebouw en) eigen woning voor eigen hulpverleners<\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_12_56'><div class='gchoice gchoice_12_56_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_56.1' type='checkbox'  value='Ik zorg ervoor dat mijn hulpverleners een sleutel (of toegang tot een sleutelkluis met sleutel) hebben waarmee ze in mijn (gebouw en) woning kunnen komen voordat ik het alarm ontvang.'  id='choice_12_56_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_56_1' id='label_12_56_1' class='gform-field-label gform-field-label--type-inline'>Ik zorg ervoor dat mijn hulpverleners een sleutel (of toegang tot een sleutelkluis met sleutel) hebben waarmee ze in mijn (gebouw en) woning kunnen komen voordat ik het alarm ontvang.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_12_57' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Vorige'  \/> <input type='button' id='gform_next_button_12_57' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_12_5' class='gform_page' data-js='page-field-id-57' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_12_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_12_58\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>9. Uw huisarts<\/h3><\/div><fieldset id=\"field_12_59\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_hidden_label gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Naam<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix no_first_name no_middle_name has_last_name no_suffix gf_name_has_1 ginput_container_name gform-grid-row' id='input_12_59'>\n                            \n                            \n                            \n                            <span id='input_12_59_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_59.6' id='input_12_59_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_12_59_6' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Achternaam<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_12_60\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_60'>Telefoonnummer<\/label><div class='ginput_container ginput_container_phone'><input name='input_60' id='input_12_60' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_12_62\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>10. Opmerking (vrij tekst)<\/h3><\/div><div id=\"field_12_63\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_63'>Opmerkingen<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_63' id='input_12_63' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_12_64\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>11. Uploaden medische indicatie<\/h3>\nWilt u in aanmerking komen voor mogelijke vergoeding van een deel van de kosten van uw alarm? Upload dan uw medische indicatie ter beoordeling.<\/div><div id=\"field_12_65\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_65'>Bestand<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='16777216' \/><input name='input_65' id='input_12_65' type='file' class='large' aria-describedby=\"gfield_upload_rules_12_65\" onchange='javascript:gformValidateFileSize( this, 16777216 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_12_65'>Max. bestandsgrootte: 16 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_12_65'><\/div> <\/div><\/div><div id=\"field_12_66\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>12. Voorwaarden en betaling<\/h3><\/div><div id=\"field_12_67\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_67'>Bankrekeningnummer(IBAN)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_12_67' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_12_68\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Ik ga akkoord met de volgende voorwaarden:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_68.1' id='input_12_68_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_12_68_1' >Ik ga akkoord met de volgende voorwaarden:<span class=\"gfield_required gfield_required_text\">(Vereist)<\/span><\/label><input type='hidden' name='input_68.2' value='Ik ga akkoord met de volgende voorwaarden:' class='gform_hidden' \/><input type='hidden' name='input_68.3' value='5' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_12_69\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><ul>\n        <li>Ik huur de apparatuur voor ten minste een periode van drie maanden, daarna kan ik maandelijks opzeggen.<\/li>\n        <li>Ik geef RSVO-alarmering toestemming om mijn gegevens en die van mijn hulpverleners te delen met hulpverleners en servicepartners voor de volgende doelen:\n            <ul>\n                <li>Goed laten functioneren van de aangevraagde producten en diensten<\/li>\n                <li>Financi\u00eble afwikkeling van en controle op de geleverde producten en diensten<\/li>\n                <li>Onderzoek naar aanleiding van klachten, incidenten of noodgevallen<\/li>\n            <\/ul>\n        <\/li>\n        <li>Ik informeer mijn mantelzorgers over de voorwaarden als hulpverlener, zie <a href=\"https:\/\/rsvo-alarmering.nl\/wp-content\/uploads\/2025\/09\/Handleiding-voor-hulpverleners.pdf\" target=\"_blank\">handleiding voor hulpverleners.<\/a><\/li>\n        <li>Ik laat het RSVO-alarmering zo snel mogelijk weten als iets in de nu door mij opgegeven zaken verandert.<\/li>\n        <li>Ik heb mijn e-mailadres (of van mijn contactpersoon) ingevuld zodat RSVO-alarmering mij kan informeren over belangrijke wijzigingen en jaarlijks kan controleren of mijn gegevens nog kloppen.<\/li>\n        <li>Voor het <b>Uit &#038; Thuisalarm<\/b> geef ik toestemming dat de volgende personen inzicht hebben in mijn actuele GPS locaties:\n            <ul>\n                <li>Medewerker van RSVO<\/li>\n                <li>Gebruiker van de app voor de familie als u alarmeert<\/li>\n                <li>Alarmcentralist als u alarmeert zodat de hulpverleners naar de juiste locatie gestuurd kunnen worden<\/li>\n            <\/ul>\n        <\/li>\n        <li>Voor het <b>Uit &#038; Thuisalarm<\/b> geef ik toestemming dat de alarmcentralist de historie van mijn GPS locaties mag raadplegen als ik alarmeer als dat helpt om mijn locatie nauwkeuriger vast te stellen.<\/li>\n        <li><a href=\"https:\/\/rsvo-alarmering.nl\/wp-content\/uploads\/2025\/09\/Privacyverklaring-1.6.pdf\" target=\"_blank\">Privacyvoorwaarden<\/a><\/li>\n    <\/ul><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_12' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Vorige'  \/> <input type='submit' id='gform_submit_button_12' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Versturen'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_12' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_12' id='gform_theme_12' value='orbital' 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