{"id":2139,"date":"2026-06-01T19:33:41","date_gmt":"2026-06-01T19:33:41","guid":{"rendered":"https:\/\/kleintierpraxiswilms.de\/?page_id=2139"},"modified":"2026-08-04T19:54:02","modified_gmt":"2026-08-04T19:54:02","slug":"neukundenformular-2","status":"publish","type":"page","link":"https:\/\/kleintierpraxiswilms.de\/en\/neukundenformular-2\/","title":{"rendered":"Initial registration form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2139\" class=\"elementor elementor-2139\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a4598e9 e-flex e-con-boxed e-con e-parent\" data-id=\"a4598e9\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c979982 elementor-widget elementor-widget-heading\" data-id=\"c979982\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Aufnahmeformular f\u00fcr Neukunden<\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0983663 e-flex e-con-boxed e-con e-parent\" data-id=\"0983663\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7ca7f32 e-flex e-con-boxed e-con e-parent\" data-id=\"7ca7f32\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4a90094 elementor-widget elementor-widget-text-editor\" data-id=\"4a90094\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Mit unserem Neukundenformular k\u00f6nnen Sie bequem und einfach Ihre Kunden- und Patientendaten an uns \u00fcbermitteln. Bitte vereinbaren Sie erst einen Termin, bevor Sie das Neukundenformular ausgef\u00fcllt an uns abschicken.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f154858 elementor-widget elementor-widget-heading\" data-id=\"f154858\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Wir sind eine Terminpraxis<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1cdadc2 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"1cdadc2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\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<div class=\"elementor-element elementor-element-bb6f22a e-flex e-con-boxed e-con e-child\" data-id=\"bb6f22a\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-5e1019f e-con-full e-flex e-con e-child\" data-id=\"5e1019f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-f3cb0e2 elementor-widget-mobile__width-initial elementor-view-default elementor-widget elementor-widget-icon\" data-id=\"f3cb0e2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"icon.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-icon-wrapper\">\n\t\t\t<div class=\"elementor-icon\">\n\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" id=\"Ebene_1\" x=\"0px\" y=\"0px\" viewBox=\"0 0 512 512\" style=\"enable-background:new 0 0 512 512;\" xml:space=\"preserve\"><style type=\"text\/css\">\t.st0123{fill:#004671;}\t.st1123{fill:#D67233;}\t.st2123{fill:#FFFFFF;}<\/style><g id=\"icons_kontakt2\">\t<g id=\"Pfad_53\">\t\t<path class=\"st0123\" d=\"M402,39.6H49.6c-25.9,0-46.9,21-46.9,46.9v201.1c0,25.9,21,46.9,46.9,46.9h25.4v57c0,3.7,3,6.8,6.8,6.8   c1.6,0,3.2-0.6,4.4-1.6l73.3-62.2h94.9v-27.7c0-24,19.5-43.5,43.5-43.5h151V86.5C448.9,60.6,427.9,39.6,402,39.6L402,39.6z\"><\/path>\t<\/g>\t<g id=\"Pfad_54\">\t\t<path class=\"st1123\" d=\"M483.2,280.7H298c-14.4,0-26,11.7-26,26v98c0,14.4,11.7,26,26,26h109l47.1,40c3.1,2.6,7.7,2.2,10.3-0.9   c1.1-1.3,1.7-3,1.7-4.7v-34.4h17.1c14.4,0,26-11.7,26-26v-97.9C509.3,292.4,497.6,280.7,483.2,280.7z\"><\/path>\t<\/g>\t<g id=\"Gruppe_35\">\t\t<g id=\"Pfad_55\">\t\t\t<path class=\"st2123\" d=\"M323,164.1H93.7c-9.4-0.2-16.9-8-16.7-17.5c0.2-9.1,7.6-16.5,16.7-16.7H323c9.4,0.2,16.9,8,16.7,17.5    C339.5,156.5,332.1,163.9,323,164.1z\"><\/path>\t\t<\/g>\t<\/g>\t<g id=\"Gruppe_36\">\t\t<g id=\"Pfad_56\">\t\t\t<path class=\"st2123\" d=\"M198.6,239.7H93.7c-9.4-0.2-16.9-8-16.7-17.5c0.2-9.1,7.6-16.5,16.7-16.7h104.9c9.4-0.2,17.2,7.3,17.5,16.7    s-7.3,17.2-16.7,17.5C199.1,239.7,198.9,239.7,198.6,239.7L198.6,239.7z\"><\/path>\t\t<\/g>\t<\/g>\t<g id=\"Gruppe_37\">\t\t<g id=\"Ellipse_38\">\t\t\t<circle class=\"st2123\" cx=\"335\" cy=\"355.7\" r=\"17.2\"><\/circle>\t\t<\/g>\t\t<g id=\"Ellipse_39\">\t\t\t<circle class=\"st2123\" cx=\"390.6\" cy=\"355.7\" r=\"17.2\"><\/circle>\t\t<\/g>\t\t<g id=\"Ellipse_40\">\t\t\t<circle class=\"st2123\" cx=\"446.2\" cy=\"355.7\" r=\"17.2\"><\/circle>\t\t<\/g>\t<\/g><\/g><\/svg>\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-8f99504 e-con-full e-flex e-con e-child\" data-id=\"8f99504\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-66c4043 elementor-widget elementor-widget-text-editor\" data-id=\"66c4043\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Terminvereinbarung<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-968be4f elementor-widget__width-inherit elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"968be4f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\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 class=\"elementor-element elementor-element-f1a0360 elementor-widget__width-auto elementor-widget elementor-widget-text-editor\" data-id=\"f1a0360\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Telefon<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-69a7181 elementor-widget__width-auto elementor-widget elementor-widget-text-editor\" data-id=\"69a7181\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>+49 221 222 333 77<\/p>\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\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3875174 elementor-widget-divider--view-line elementor-widget elementor-widget-divider\" data-id=\"3875174\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\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\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-18c7150 e-con e-atomic-element e-flexbox-base e-8dcbbec \" data-id=\"18c7150\" data-element_type=\"e-flexbox\" data-e-type=\"e-flexbox\" data-interaction-id=\"18c7150\" data-e-type=\"e-flexbox\" data-id=\"18c7150\">\n    \t\t\t<h2 data-interaction-id=\"1c9f5da\" class=\"e-heading-base\" data-e-type=\"widget\" data-id=\"1c9f5da\">Neukundenformular<\/h2>\n\t\t\t\t<div class=\"elementor-element elementor-element-fb17bcd elementor-widget elementor-widget-text-editor\" data-id=\"fb17bcd\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Die mit * markierten Felder sind Pflichtangaben<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-53dcfd3 fluentform-widget-submit-button-custom elementor-widget elementor-widget-fluent-form-widget\" data-id=\"53dcfd3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"fluent-form-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n            <div class=\"fluentform-widget-wrapper fluentform-widget-align-default\">\n\n            \n            <div class='fluentform ff-default fluentform_wrapper_3 ffs_default_wrap'><form data-form_id=\"3\" id=\"fluentform_3\" class=\"frm-fluent-form fluent_form_3 ff-el-form-top ff_form_instance_3_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_3_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Neukundenformular<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='2139' \/><input type=\"hidden\" id=\"_fluentform_3_fluentformnonce\" name=\"_fluentform_3_fluentformnonce\" value=\"6b4fa61a8a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/2139\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_1\" ><h1>Ihr vereinbarter Termin<\/h1><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_datetime' id='label_ff_3_datetime' aria-label=\"Datum\">Datum<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Datum Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_3_datetime\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_2\" ><h1>Ihre Kundendaten<\/h1><\/div><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 ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_names_first_name_' id='label_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\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_names_last_name_' id='label_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\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--label'><label aria-label=\"Adresse\">Adresse<\/label><\/div><div class='ff-el-input--content'><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_address_1_address_line_1_' id='label_ff_3_address_1_address_line_1_' aria-label=\"Strasse\">Strasse<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_3_address_1_address_line_1_\" class=\"ff-el-form-control\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/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_address_1_city_' id='label_ff_3_address_1_city_' aria-label=\"Stadt\">Stadt<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_3_address_1_city_\" class=\"ff-el-form-control\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><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_address_1_zip_' id='label_ff_3_address_1_zip_' aria-label=\"Postleitzahl\">Postleitzahl<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_3_address_1_zip_\" class=\"ff-el-form-control\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/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_numeric_field' id='label_ff_3_numeric_field' aria-label=\"Telefon\">Telefon<\/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\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_email' id='label_ff_3_email' aria-label=\"E-Mail\">E-Mail<\/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\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_datetime_1' id='label_ff_3_datetime_1' aria-label=\"Geburtsdatum (nur erforderlich bei Ratenzahlung)\">Geburtsdatum (nur erforderlich bei Ratenzahlung)<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Geburtsdatum (nur erforderlich bei Ratenzahlung) Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_1\" id=\"ff_3_datetime_1\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_1\"  aria-invalid='false' aria-required=false><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_3\" ><p>Patientendaten<\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text' id='label_ff_3_input_text' aria-label=\"Rufname des Tieres\">Rufname des Tieres<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_3_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_datetime_2' id='label_ff_3_datetime_2' aria-label=\"Geburtstdatum\">Geburtstdatum<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Geburtstdatum Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_2\" id=\"ff_3_datetime_2\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_2\"  aria-invalid='false' aria-required=false><\/div><\/div><div class='ff-el-group  ff_list_inline'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Tierart\">Tierart<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2ffc2fa212cbe19545bc0429eba40845'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Hund\"  id='checkbox_2ffc2fa212cbe19545bc0429eba40845' aria-label='Hund' aria-invalid='false' aria-required=true> <span>Hund<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_c3017003d1bc5e1c9040dc7fefe04fd9'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Katze\"  id='checkbox_c3017003d1bc5e1c9040dc7fefe04fd9' aria-label='Katze' aria-invalid='false' aria-required=true> <span>Katze<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_92aef61cb5a6f6d336d2a12d79bf1eaa'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Sonstige\"  id='checkbox_92aef61cb5a6f6d336d2a12d79bf1eaa' aria-label='Sonstige' aria-invalid='false' aria-required=true> <span>Sonstige<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_1' id='label_ff_3_input_text_1' aria-label=\"Tierart (nur bei Auswahl &quot;Sonstige&quot;)\">Tierart (nur bei Auswahl \"Sonstige\")<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_3_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_2' id='label_ff_3_input_text_2' aria-label=\"Rasse\">Rasse<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_3_input_text_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff_list_3col'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Geschlecht\">Geschlecht<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_e66eba907ea1209a0683ac0c73404a7f'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"M\u00e4nnlich\"  id='checkbox_1_e66eba907ea1209a0683ac0c73404a7f' aria-label='M\u00e4nnlich' aria-invalid='false' aria-required=true> <span>M\u00e4nnlich<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_f7472d5c392be57fdd1bd6f5c597f80e'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Weiblich\"  id='checkbox_1_f7472d5c392be57fdd1bd6f5c597f80e' aria-label='Weiblich' aria-invalid='false' aria-required=true> <span>Weiblich<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_e4085ae4c3efc12bfd25cb20339b376a'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Kastriert\"  id='checkbox_1_e4085ae4c3efc12bfd25cb20339b376a' aria-label='Kastriert' aria-invalid='false' aria-required=true> <span>Kastriert<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_3' id='label_ff_3_input_text_3' aria-label=\"Gewicht (kg)\">Gewicht (kg)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" data-name=\"input_text_3\" id=\"ff_3_input_text_3\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_3_input_text_4' id='label_ff_3_input_text_4' aria-label=\"Farbe\/Abzeichen\">Farbe\/Abzeichen<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" id=\"ff_3_input_text_4\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff_list_2col'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Implantierter Chip\">Implantierter Chip<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_e225c723a7688a45ee11ea419b514d1b'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Ja\"  id='checkbox_2_e225c723a7688a45ee11ea419b514d1b' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_3ac1781e82c4b8b10e6b70ae31440e27'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nein\"  id='checkbox_2_3ac1781e82c4b8b10e6b70ae31440e27' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_5' id='label_ff_3_input_text_5' aria-label=\"Chipnummer\">Chipnummer<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" data-name=\"input_text_5\" id=\"ff_3_input_text_5\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff_list_3col'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Vorerkrankungen\">Vorerkrankungen<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_85243b683f64a940584dc5898b4ad9fc'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nein\"  id='checkbox_3_85243b683f64a940584dc5898b4ad9fc' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_c2d2d38b07f2a42705739aeb11dc020f'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Ja\"  id='checkbox_3_c2d2d38b07f2a42705739aeb11dc020f' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_770c0fa629c2076754d5062f2f28d405'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nicht bekannt\"  id='checkbox_3_770c0fa629c2076754d5062f2f28d405' aria-label='Nicht bekannt' aria-invalid='false' aria-required=true> <span>Nicht bekannt<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" placeholder=\"Beschreibung eingeben\" data-name=\"input_text_6\" id=\"ff_3_input_text_6\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff_list_3col'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Medikamente\">Medikamente<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_657ec36e32ee9d44436c62e019c28e88'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nein\"  id='checkbox_4_657ec36e32ee9d44436c62e019c28e88' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_946ff335fa792c9ee441c0bdc4645d25'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Ja\"  id='checkbox_4_946ff335fa792c9ee441c0bdc4645d25' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_8e5bc7108a3b3cbf05acd1895d834265'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nicht bekannt\"  id='checkbox_4_8e5bc7108a3b3cbf05acd1895d834265' aria-label='Nicht bekannt' aria-invalid='false' aria-required=true> <span>Nicht bekannt<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_7\" class=\"ff-el-form-control\" placeholder=\"Beschreibung eingeben\" data-name=\"input_text_7\" id=\"ff_3_input_text_7\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff_list_3col'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Unvertr\u00e4glichkeiten von Medikamenten\">Unvertr\u00e4glichkeiten von Medikamenten<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_f657ac2699fa364fef548be1429ec653'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nein\"  id='checkbox_5_f657ac2699fa364fef548be1429ec653' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_bffa29f8bca1aa699f97f15c4f4acfa3'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Ja\"  id='checkbox_5_bffa29f8bca1aa699f97f15c4f4acfa3' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_b1467cc52ae4e45452aa6ccfc31e2f62'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nicht bekannt\"  id='checkbox_5_b1467cc52ae4e45452aa6ccfc31e2f62' aria-label='Nicht bekannt' aria-invalid='false' aria-required=true> <span>Nicht bekannt<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_8\" class=\"ff-el-form-control\" placeholder=\"Beschreibung eingeben\" data-name=\"input_text_8\" id=\"ff_3_input_text_8\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff_list_3col'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Tierkranken- oder OP-Versicherung\">Tierkranken- oder OP-Versicherung<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6_d3bca0f9f9c0c891a8cebf1df36e40a0'><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nein\"  id='checkbox_6_d3bca0f9f9c0c891a8cebf1df36e40a0' aria-label='Nein' aria-invalid='false' aria-required=true> <span>Nein<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6_18d3c95f2c0151a643ed2eef59cf0f04'><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Ja\"  id='checkbox_6_18d3c95f2c0151a643ed2eef59cf0f04' aria-label='Ja' aria-invalid='false' aria-required=true> <span>Ja<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_6_8a8d963377e5e1cfc2f6672a6fb99f5e'><input  type=\"checkbox\" name=\"checkbox_6[]\" data-name=\"checkbox_6\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"Nicht bekannt\"  id='checkbox_6_8a8d963377e5e1cfc2f6672a6fb99f5e' aria-label='Nicht bekannt' aria-invalid='false' aria-required=true> <span>Nicht bekannt<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_9' id='label_ff_3_input_text_9' aria-label=\"Versichert bei\">Versichert bei<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_9\" class=\"ff-el-form-control\" data-name=\"input_text_9\" id=\"ff_3_input_text_9\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_10' id='label_ff_3_input_text_10' aria-label=\"Versichert seit\">Versichert seit<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_10\" class=\"ff-el-form-control\" data-name=\"input_text_10\" id=\"ff_3_input_text_10\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_11' id='label_ff_3_input_text_11' aria-label=\"Vertragsnummer\">Vertragsnummer<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_11\" class=\"ff-el-form-control\" data-name=\"input_text_11\" id=\"ff_3_input_text_11\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_3_input_text_12' id='label_ff_3_input_text_12' aria-label=\"\u00dcberwiesen \/ Empfohlen von \/ erfahren durch\">\u00dcberwiesen \/ Empfohlen von \/ erfahren durch<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_12\" class=\"ff-el-form-control\" data-name=\"input_text_12\" id=\"ff_3_input_text_12\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Terms and Conditions: Ich habe die AGB gelesen und akzeptiere die Bedingungen! Contains 1 link. Use tab navigation to review.' class='ff-el-form-check-label ff_tc_label' for=terms-n-condition_58ec1c7aa7e071e7c4d8c4b5566ae037><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition\" id=\"terms-n-condition_58ec1c7aa7e071e7c4d8c4b5566ae037\"  value='on' aria-invalid='false' aria-required=false><\/span> <div class='ff_t_c'><p>Ich habe die <a href=\"https:\/\/kleintierpraxiswilms.de\/agb\/\" target=\"_blank\" rel=\"noopener\">AGB<\/a> gelesen und akzeptiere die Bedingungen!<\/p><\/div><\/label><\/div><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Terms and Conditions: Ich habe die Datenschutzerkl\u00e4rung zur Kenntnis genmommen!\n&nbsp; Contains 1 link. Use tab navigation to review.' class='ff-el-form-check-label ff_tc_label' for=terms-n-condition_1_bf992f0fb421ce624305b8bdb8c30ae2><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition_1\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition_1\" id=\"terms-n-condition_1_bf992f0fb421ce624305b8bdb8c30ae2\"  value='on' aria-invalid='false' aria-required=false><\/span> <div class='ff_t_c'><p>Ich habe die <a href=\"https:\/\/kleintierpraxiswilms.de\/datenschutz\/\" target=\"_blank\" rel=\"noopener\">Datenschutzerkl\u00e4rung<\/a> zur Kenntnis genmommen!<\/p>\n<p>&nbsp;<\/p><\/div><\/label><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-3_4\" ><p>Der verbindliche Behandlungs- oder Dienstleistungsvertrag kommt erst bei Wahrnehmung des Termins vor Ort in unseren Praxisr\u00e4umen zustande. Wir bitten dennoch h\u00f6flich um rechtzeitige Absage des Termins, falls Sie den Termin nicht wahrnehmen m\u00f6chten.<\/p><\/div><div class='ff-el-group ff-text-center ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\"  aria-label=\"Formular absenden\">Formular absenden<\/button><\/div><\/fieldset><\/form><div id='fluentform_3_errors' class='ff-errors-in-stack ff_form_instance_3_1 ff-form-loading_errors ff_form_instance_3_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_3_1 = {\"id\":\"3\",\"ajaxUrl\":\"https:\\\/\\\/kleintierpraxiswilms.de\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"asteriskPlacement\":\"asterisk-right\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_3_1\",\"form_id_selector\":\"fluentform_3\",\"rules\":{\"datetime\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"names[first_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"names[middle_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"names[last_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"address_1[address_line_1]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"address_1[address_line_2]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"address_1[city]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"address_1[state]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"address_1[zip]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"address_1[country]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"numeric_field\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global_message\":\"Dieses Feld muss einen numerischen Wert enthalten\",\"global\":true},\"min\":{\"value\":\"\",\"message\":\"Validation fails for minimum value\",\"global_message\":\"Validierung des Mindestwerts schl\\u00e4gt fehl\",\"global\":true},\"max\":{\"value\":\"\",\"message\":\"Validation fails for maximum value\",\"global_message\":\"Validierung schl\\u00e4gt bei Maximalwert fehl\",\"global\":true},\"digits\":{\"value\":\"\",\"message\":\"Validation fails for limited digits\",\"global_message\":\"Validierung schl\\u00e4gt bei begrenzten Ziffern fehl\",\"global\":true}},\"email\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true},\"email\":{\"value\":true,\"message\":\"This field must contain a valid email\",\"global_message\":\"Dieses Feld muss eine g\\u00fcltige E-Mail-Adresse enthalten\",\"global\":true}},\"datetime_1\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"datetime_2\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"checkbox\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text_1\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text_2\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"checkbox_1\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text_3\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text_4\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"checkbox_2\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text_5\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"checkbox_3\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text_6\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"checkbox_4\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text_7\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"checkbox_5\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist erforderlich\",\"global\":true}},\"input_text_8\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global_message\":\"Dieses Feld ist 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