{"id":1361,"date":"2023-02-08T14:24:23","date_gmt":"2023-02-08T14:24:23","guid":{"rendered":"https:\/\/zorgbureaurotterdam.nl\/?page_id=1361"},"modified":"2023-04-24T11:39:24","modified_gmt":"2023-04-24T11:39:24","slug":"aanvraagformulier","status":"publish","type":"page","link":"https:\/\/zorgbureaurotterdam.nl\/aanvraagformulier\/","title":{"rendered":"Aanvraagformulier"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1361\" class=\"elementor elementor-1361\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-3ee9c27 elementor-section-boxed elementor-section-height-default elementor-section-height-default magic-button-disabled-no\" data-id=\"3ee9c27\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-fd5205b\" data-id=\"fd5205b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-4871827 elementor-widget elementor-widget-text-editor\" data-id=\"4871827\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.20.0 - 26-03-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>Wilt u zich aanmelden voor zorg bij Zorgbureau Rotterdam? U bent natuurlijk van harte welkom bij ons. Vul het onderstaande formulier in.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f57566d elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"f57566d\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor-pro - v3.17.0 - 01-11-2023 *\/\n.elementor-button.elementor-hidden,.elementor-hidden{display:none}.e-form__step{width:100%}.e-form__step:not(.elementor-hidden){display:flex;flex-wrap:wrap}.e-form__buttons{flex-wrap:wrap}.e-form__buttons,.e-form__buttons__wrapper{display:flex}.e-form__indicators{display:flex;justify-content:space-between;align-items:center;flex-wrap:nowrap;font-size:13px;margin-bottom:var(--e-form-steps-indicators-spacing)}.e-form__indicators__indicator{display:flex;flex-direction:column;align-items:center;justify-content:center;flex-basis:0;padding:0 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.e-font-icon-svg{height:1em}.e-form__indicators__indicator__number{width:var(--e-form-steps-indicator-padding,30px);height:var(--e-form-steps-indicator-padding,30px);border-width:1px;border-style:solid;display:flex;justify-content:center;align-items:center;margin-bottom:10px}.e-form__indicators__indicator--shape-circle{border-radius:50%}.e-form__indicators__indicator--shape-square{border-radius:0}.e-form__indicators__indicator--shape-rounded{border-radius:5px}.e-form__indicators__indicator--shape-none{border:0}.e-form__indicators__indicator__label{text-align:center}.e-form__indicators__indicator__separator{width:100%;height:var(--e-form-steps-divider-width);background-color:#babfc5}.e-form__indicators--type-icon,.e-form__indicators--type-icon_text,.e-form__indicators--type-number,.e-form__indicators--type-number_text{align-items:flex-start}.e-form__indicators--type-icon .e-form__indicators__indicator__separator,.e-form__indicators--type-icon_text .e-form__indicators__indicator__separator,.e-form__indicators--type-number .e-form__indicators__indicator__separator,.e-form__indicators--type-number_text .e-form__indicators__indicator__separator{margin-top:calc(var(--e-form-steps-indicator-padding, 30px) \/ 2 - var(--e-form-steps-divider-width, 1px) \/ 2)}.elementor-field-type-hidden{display:none}.elementor-field-type-html{display:inline-block}.elementor-login .elementor-lost-password,.elementor-login .elementor-remember-me{font-size:.85em}.elementor-field-type-recaptcha_v3 .elementor-field-label{display:none}.elementor-field-type-recaptcha_v3 .grecaptcha-badge{z-index:1}.elementor-button .elementor-form-spinner{order:3}.elementor-form .elementor-button>span{display:flex;justify-content:center;align-items:center}.elementor-form .elementor-button .elementor-button-text{white-space:normal;flex-grow:0}.elementor-form .elementor-button svg{height:auto}.elementor-form .elementor-button .e-font-icon-svg{height:1em}.elementor-select-wrapper .select-caret-down-wrapper{position:absolute;top:50%;transform:translateY(-50%);inset-inline-end:10px;pointer-events:none;font-size:11px}.elementor-select-wrapper .select-caret-down-wrapper svg{display:unset;width:1em;aspect-ratio:unset;fill:currentColor}.elementor-select-wrapper .select-caret-down-wrapper i{font-size:19px;line-height:2}.elementor-select-wrapper.remove-before:before{content:\"\"!important}<\/style>\t\t<form class=\"elementor-form\" method=\"post\" name=\"Contactformulier\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1361\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"f57566d\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_9989fb7 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9989fb7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIk wil zorg aanvragen voor\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_9989fb7]\" id=\"form-field-field_9989fb7\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t<option value=\"Hulp bij het huishouden\">Hulp bij het huishouden<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Begeleiding\">Begeleiding<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Dagbesteding\">Dagbesteding<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Verpleging &amp; verzorging\">Verpleging &amp; verzorging<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Palliatieve zorg\">Palliatieve zorg<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Casemanagement Dementie\">Casemanagement Dementie<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-name elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAanhef\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Dhr.\" id=\"form-field-name-0\" name=\"form_fields[name]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-name-0\">Dhr.<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Mw.\" id=\"form-field-name-1\" name=\"form_fields[name]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-name-1\">Mw.<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_9e870de elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9e870de\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVoornaam\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_9e870de]\" id=\"form-field-field_9e870de\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"voornaam\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_2ba9c31 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2ba9c31\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAchternaam\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_2ba9c31]\" id=\"form-field-field_2ba9c31\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"achternaam\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_bd8fbe1 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bd8fbe1\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAdres\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_bd8fbe1]\" id=\"form-field-field_bd8fbe1\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Adres\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_a86e1ff elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_a86e1ff\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPostcode\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_a86e1ff]\" id=\"form-field-field_a86e1ff\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"postcode\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_6f464e2 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_6f464e2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPlaats\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_6f464e2]\" id=\"form-field-field_6f464e2\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Plaats\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_faf8765 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_faf8765\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTelefoonnummer\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_faf8765]\" id=\"form-field-field_faf8765\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Telefoonnummer\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email_hidden elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email_hidden\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHidden Email\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email_hidden]\" id=\"form-field-email_hidden\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Email\" value=\"info@zorgbureaurotterdam.nl\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tOpmerking of vraag:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[message]\" id=\"form-field-message\" rows=\"4\" placeholder=\"Mijn vraag gaat over\" required=\"required\" aria-required=\"true\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_99d48bd elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_99d48bd]\" id=\"form-field-field_99d48bd\" class=\"elementor-field elementor-size-sm  elementor-acceptance-field\" required=\"required\" aria-required=\"true\">\n\t\t\t\t<label for=\"form-field-field_99d48bd\">Ik ben akkoord met de <a href=\"https:\/\/zorgbureaurotterdam.nl\/privacy-verklaring\/\">Privacy Policy van Zorgbureau Rotterdam.<\/a> *\n<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button type=\"submit\" class=\"elementor-button elementor-size-sm\">\n\t\t\t\t\t\t<span >\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\" elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Verzenden<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Wilt u zich aanmelden voor zorg bij Zorgbureau Rotterdam? U bent natuurlijk van harte welkom bij ons. 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