{"id":513,"date":"2023-04-22T11:05:16","date_gmt":"2023-04-22T09:05:16","guid":{"rendered":"https:\/\/cardiosurvivor.ch\/anmeldung\/"},"modified":"2023-04-25T12:26:38","modified_gmt":"2023-04-25T10:26:38","slug":"enrollment","status":"publish","type":"page","link":"https:\/\/cardiosurvivor.ch\/en\/enrollment\/","title":{"rendered":"Enrollment"},"content":{"rendered":"<div  class=\"page-section style-lavender\">\n\t<div class=\"section-grid grid-layout\"><div  style=\"--grid-layout-index: 1; --col-xs: 2; --col-sm: 2; --col-md: 2; --col-lg: 2; --col-xl: 2\" class=\"section-item\"><div class=\"cell style-default\"><h1>Enrollment<\/h1>\n\n<div class=\"wpforms-container \" id=\"wpforms-580\"><form id=\"wpforms-form-580\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"580\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/513\" data-token=\"3adef2f2cbb623ab485e5fa2c5de98ce\" data-token-time=\"1776846560\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-580-field_7-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"7\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-580-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_2\">Last Name, First Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-580-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-580-field_18-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_18\">Birthday <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-580-field_18\" class=\"wpforms-field-medium wpforms-field-required wpforms-masked-input\" data-rule-inputmask-incomplete=\"1\" data-inputmask-mask=\"99.99.9999\" name=\"wpforms[fields][18]\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-580-field_8-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"8\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-580-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_9\">Street and Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-580-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-580-field_10-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_10\">ZIP and City <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-580-field_10\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][10]\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-580-field_11-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"11\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-580-field_14-container\" class=\"wpforms-field wpforms-field-phone\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_14\">Phone Number <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-580-field_14\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][14]\" aria-label=\"Phone Number\" required><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-580-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_4\">Email Address <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-580-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" spellcheck=\"false\" required><\/div><\/div><\/div><\/div><div id=\"wpforms-580-field_19-container\" class=\"wpforms-field wpforms-field-layout\" data-field-id=\"19\"><div class=\"wpforms-field-layout-columns wpforms-field-layout-preset-50-50\"><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-580-field_21-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"21\"><ul id=\"wpforms-580-field_21\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-580-field_21_1\" name=\"wpforms[fields][21][]\" value=\"I would like to make an appointment at the &quot;cardiac aftercare consultation&quot;.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-580-field_21_1\">I would like to make an appointment at the &#8220;cardiac aftercare consultation&#8221;.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-580-field_21_2\" name=\"wpforms[fields][21][]\" value=\"I have already had a cardiac examination in the last 5 years.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-580-field_21_2\">I have already had a cardiac examination in the last 5 years.<\/label><\/li><\/ul><\/div><\/div><div class=\"wpforms-layout-column wpforms-layout-column-50\" ><div id=\"wpforms-580-field_24-container\" class=\"wpforms-field wpforms-field-content\" data-field-id=\"24\"><div id=\"wpforms-580-field_24\" class=\"wpforms-field-medium wpforms-field-row\"><p>Voluntary:<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-580-field_25-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_25\">Name of the cardiac specialist<\/label><input type=\"text\" id=\"wpforms-580-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" ><\/div><div id=\"wpforms-580-field_26-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_26\">Location (practice address or hospital)<\/label><input type=\"text\" id=\"wpforms-580-field_26\" class=\"wpforms-field-medium\" name=\"wpforms[fields][26]\" ><\/div><div id=\"wpforms-580-field_27-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_27\">Approximate date of last examination (year)<\/label><input type=\"text\" id=\"wpforms-580-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" ><\/div><div id=\"wpforms-580-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"28\"><ul id=\"wpforms-580-field_28\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-580-field_28_1\" name=\"wpforms[fields][28][]\" value=\"The study team may request my records from the mentioned cardiac specialist for study purposes.\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-580-field_28_1\">The study team may request my records from the mentioned cardiac specialist for study purposes.<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div id=\"wpforms-580-field_5-container\" class=\"wpforms-field wpforms-field-captcha\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-580-field_5\">Spam Protection <span class=\"wpforms-required-label\">*<\/span><\/label>\t\t\t<div class=\"wpforms-captcha-math\">\n\t\t\t\t<span id=\"wpforms-580-field_5-question\" class=\"wpforms-captcha-equation\">\n\t\t\t\t\t<span class=\"n1\">4<\/span>\n\t\t\t\t\t\t\t<span class=\"cal\">+<\/span>\n\t\t\t\t\t\t\t<span class=\"n2\">6<\/span>\t\t\t\t\t<span class=\"e\">=<\/span>\n\t\t\t\t<\/span>\n\t\t\t\t<input type=\"text\" id=\"wpforms-580-field_5\" class=\"wpforms-field-medium wpforms-field-required a\" data-rule-wpf-captcha=\"math\" data-is-wrapped-field=\"1\" name=\"wpforms[fields][5][a]\" aria-describedby=\"wpforms-580-field_5-question\" required>\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][5][cal]\" class=\"cal\">\n\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][5][n2]\" class=\"n2\">\n\t\t\t\t<input type=\"hidden\" name=\"wpforms[fields][5][n1]\" class=\"n1\">\n\t\t\t<\/div>\n\t\t\t<div class=\"wpforms-field-description\">Please solve the following problem to prove that you are human.<\/div><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"580\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/pages\/513\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-580\" class=\"wpforms-submit\" data-alt-text=\"Submitting...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/cardiosurvivor.ch\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container --><\/div><\/div><\/div>\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Enrollment Please enable JavaScript in your browser to complete this form.Last Name, First Name *Birthday *Street and Number *ZIP and City *Phone Number *Email Address *I would like to make an appointment at the &#8220;cardiac aftercare consultation&#8221;.I have already had a cardiac examination in the last 5 years.Voluntary: Name of the cardiac specialistLocation (practice address [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-513","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/pages\/513","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/comments?post=513"}],"version-history":[{"count":2,"href":"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/pages\/513\/revisions"}],"predecessor-version":[{"id":591,"href":"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/pages\/513\/revisions\/591"}],"wp:attachment":[{"href":"https:\/\/cardiosurvivor.ch\/en\/wp-json\/wp\/v2\/media?parent=513"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}