{"id":4615,"date":"2026-06-11T07:07:05","date_gmt":"2026-06-11T05:07:05","guid":{"rendered":"https:\/\/www.skoliosenetzwerkoesterreich.at\/experten\/form\/eintrag-in-die-expertensuche-copy-4\/"},"modified":"2026-06-11T12:43:45","modified_gmt":"2026-06-11T10:43:45","slug":"eintrag-in-die-expertensuche-copy-4","status":"publish","type":"formgent_form","link":"https:\/\/www.skoliosenetzwerkoesterreich.at\/experten\/form\/eintrag-in-die-expertensuche-copy-4\/","title":{"rendered":"Eintrag in die Expertensuche &#8211; Orthop\u00e4die"},"content":{"rendered":"\n<style>\n    .formgent-form-4615 {\n        \/* Form variables *\/\n        --formgent-form-background-color: #ffffff;\n        --formgent-form-background-image: ;\n        --formgent-form-background-image-position:\n        center center;\n\n        --formgent-form-padding-desktop: 20px 20px 40px 20px;\n        --formgent-form-padding-tablet: 20px 20px 40px 20px;\n        --formgent-form-padding-mobile: 20px 20px 40px 20px;\n        --formgent-form-margin-desktop: 0 0 0 0;\n        --formgent-form-margin-tablet: 0 0 0 0;\n        --formgent-form-margin-mobile: 0 0 0 0;\n        --formgent-form-border-width: 0;\n        --formgent-form-border: 0 solid transparent;\n        --formgent-form-border-radius: 16px 16px 16px 16px;\n\n        \/* Field variables *\/\n        --formgent-field-vertical-spacing-desktop: 35px;\n        --formgent-field-vertical-spacing-tablet: 35px;\n        --formgent-field-vertical-spacing-mobile: 35px;\n        --formgent-field-horizontal-spacing-desktop: 12px;\n        --formgent-field-horizontal-spacing-tablet: 12px;\n        --formgent-field-horizontal-spacing-mobile: 12px;\n        --formgent-field-background-color: transparent;\n        --formgent-field-background-color-hover: transparent;\n        --formgent-field-placeholder-color: #a1a9b2;\n        --formgent-field-label-color: #000000;\n        --formgent-field-description-color: #747c89;\n        --formgent-field-error-message-color: #c83a3a;\n        --formgent-field-input-color: #4d5761 ;\n        --formgent-field-options-color: #4d5761;\n        --formgent-field-border: 1px solid #d2d6db;\n        --formgent-field-border-radius: 8px 8px 8px 8px;\n        --formgent-field-rating-color: #a1a9b2;\n        --formgent-field-rating-color-hover: #5e53f9;\n        --formgent-field-range-slider-color: #000000;\n        \/* Fixed submit button variables *\/\n        --formgent-fixed-btn-bg-color: #000000;\n        --formgent-fixed-btn-text-color: #ffffff;\n        --formgent-fixed-btn-border-color: #000000;\n        --formgent-fixed-btn-style: default;\n        --formgent-fixed-btn-alignment: left;\n    }\n    .display-none {\n        display: none;\n    }\n<\/style><style>\n    <\/style>\n<div class=\"formgent-form formgent-form-4615 formgent-form-general \">\n            <div class=\"formgent-confirmation-wrap formgent-confirmation-wrap--hidden\">\n            <div class=\"formgent-notices formgent-notices--classic-form\"\n                data-message=\"&lt;div&gt;\n&lt;div&gt;\n&lt;h3&gt;Vielen Dank!&lt;\/h3&gt;\n&lt;\/div&gt;\n&lt;div&gt;\n&lt;p&gt;Liebe Netzwerkpartnerin, lieber Netzwerkpartner!&lt;\/p&gt;\n&lt;\/div&gt;\n&lt;div&gt;\n&lt;p&gt;Ihr Formular ist bei uns eingegangen. Wir freuen uns, dass Sie sich f\u00fcr einen Eintrag in die neue Expertensuche entschieden haben, die am 1. September 2026 online geht.&lt;\/p&gt;\n&lt;\/div&gt;\n&lt;div&gt;\n&lt;p&gt;Ihre Daten werden bis dahin im Hintergrund verarbeitet. Eine separate E-Mail zur Best\u00e4tigung der Ver\u00f6ffentlichung wird Ihnen zugesandt.&lt;\/p&gt;\n&lt;\/div&gt;\n&lt;div&gt;\n&lt;p&gt;Bitte beachten Sie, dass diese Eintragung in die neue Expertensuche erfolgt, die am 1. September 2026 online geht. 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Expertensuche von Skoliose Netzwerk \\u00d6sterreich&quot;,&quot;site_name&quot;:&quot;Die Expertensuche von Skoliose Netzwerk \\u00d6sterreich&quot;,&quot;site_url&quot;:&quot;https:\\\/\\\/www.skoliosenetzwerkoesterreich.at\\\/experten&quot;,&quot;form_title&quot;:&quot;Eintrag in die Expertensuche - Orthop\\u00e4die&quot;,&quot;browser_name&quot;:&quot;&quot;,&quot;browser_platform&quot;:&quot;&quot;,&quot;embedded_post_id&quot;:&quot;4615&quot;,&quot;embedded_post_title&quot;:&quot;Eintrag in die Expertensuche - Orthop\\u00e4die&quot;,&quot;current_date&quot;:&quot;06\\\/28\\\/2026&quot;,&quot;admin_name&quot;:&quot;Skoliose Netzwerk \\u00d6sterreich&quot;,&quot;login_url&quot;:&quot;https:\\\/\\\/www.skoliosenetzwerkoesterreich.at\\\/experten\\\/wp-login.php&quot;,&quot;register_url&quot;:&quot;https:\\\/\\\/www.skoliosenetzwerkoesterreich.at\\\/experten\\\/wp-login.php?action=register&quot;,&quot;forgot_password_url&quot;:&quot;https:\\\/\\\/www.skoliosenetzwerkoesterreich.at\\\/experten\\\/wp-login.php?action=lostpassword&quot;,&quot;logout_url&quot;:&quot;https:\\\/\\\/www.skoliosenetzwerkoesterreich.at\\\/experten\\\/wp-login.php?action=logout\\u0026amp;_wpnonce=4b4b4c7987&quot;},&quot;is_form_loaded&quot;:false,&quot;is_partial_submitting&quot;:false,&quot;global&quot;:{&quot;is_response_submitting&quot;:false,&quot;is_response_token_generating&quot;:false,&quot;is_enabled_honeypot_protection&quot;:false,&quot;payment&quot;:{&quot;enable_summary&quot;:false,&quot;payment_summary&quot;:&quot;&quot;,&quot;items&quot;:[],&quot;total_amount&quot;:&quot;&quot;}},&quot;quiz_result&quot;:false,&quot;show_quiz_results&quot;:true,&quot;confirmation&quot;:{&quot;type&quot;:&quot;message&quot;,&quot;page&quot;:0,&quot;url&quot;:&quot;https:\\\/\\\/google.com&quot;,&quot;after_submission&quot;:&quot;reset&quot;},&quot;_ccOverride&quot;:false,&quot;_confirmationDisplayed&quot;:false,&quot;submit_label&quot;:&quot;Submit&quot;,&quot;redirecting_label&quot;:&quot;You will be redirected in&quot;,&quot;plugin_url&quot;:&quot;https:\\\/\\\/www.skoliosenetzwerkoesterreich.at\\\/experten\\\/wp-content\\\/plugins&quot;,&quot;external_data&quot;:[]}'\n        data-wp-init=\"callbacks.initClassicForm\"\n        data-wp-bind--disabled=\"context.global.is_response_submitting\" data-wp-watch=\"callbacks.watchForm\">\n                        <div class=\"formgent-field-list formgent-field-list--frontend\"\n            data-wp-class--formgent-field-list-loading=\"!context.is_form_loaded\"\n            data-wp-class--formgent-partial-submitting=\"!context.is_partial_submitting\">\n            \n<h2 data-wp-bind--hidden=\"state.hideField\" data-wp-context=\"{ &quot;name&quot;: &quot;qtcP7wk_pMn3Ak6ypgxHu&quot; }\" class=\"wp-block-heading has-text-align-center display-none\"><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-green-cyan-color\">Orthop\u00e4die -<\/mark> <mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-green-cyan-color\">Ihr Eintrag in die Online-Expertensuche von Skoliose Netzwerk \u00d6sterreich<\/mark><\/h2>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice-2&quot;,&quot;field_label&quot;:&quot;Bitte w\\u00e4hlen Sie aus&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;HZzzZmtUbKVOwRWu-Omi_&quot;,&quot;label&quot;:&quot;Eintrag meiner Praxis in die Expertensuche &quot;,&quot;value&quot;:&quot;eintrag-meiner-praxis-in-die-expertensuche&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label for=\"formgent-multiple-choice-2\"\n                class=\"formgent-field-label formgent-label-align-top\">\n                Bitte w\u00e4hlen Sie aus                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice-2 formgent-field-single__box--two_columns\"\n                id=\"formgent-lysL9kv0UaDF\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                  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value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<h4 data-wp-bind--hidden=\"state.hideField\" data-wp-context=\"{ &quot;name&quot;: &quot;OFFlhc_Dvamb3iSWtLOBe&quot; }\" class=\"wp-block-heading has-text-align-left display-none\"><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-green-cyan-color\">Informationen zu Ihrer Praxis<\/mark><\/h4>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"text-5\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-T6imJ3003YqB\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Praxisname                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-T6imJ3003YqB\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"name-2\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\" id=\"formgent-CwjPJvV6443q\">\n    <div class=\"formgent-field-single formgent-field-align-top\" data-wp-context='{ \"parent_name\": \"name-2\" }'>\n        <span class=\"formgent-field-label formgent-label-align-top\">\n        Name    <\/span>\n    \n<div class=\"formgent-field-list formgent-field-list--frontend\">\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"first_name\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-33\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-yGrfYQPDnmZh\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Titel                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-yGrfYQPDnmZh\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"middle_name\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-33\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-3wIp6ylDlrHi\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Vorname                                     <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-3wIp6ylDlrHi\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"last_name\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-33\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-j9KSySkoOz-O\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Nachname                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-j9KSySkoOz-O\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div><\/div>\n    <\/div>\n<\/div>\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"address\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\" id=\"formgent-5DrZhLrbiEcz\">\n    <div class=\"formgent-field-single formgent-field-align-top\" data-wp-context='{ \"parent_name\": \"address\" }'>\n        <span class=\"formgent-field-label formgent-label-align-top\">\n        Kontaktinformationen (bitte keine privaten Daten!)    <\/span>\n    \n<div class=\"formgent-field-list formgent-field-list--frontend\">\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"address_line_one\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-w-xfBKfjtEgY\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Stra\u00dfe und Hausnummer                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-w-xfBKfjtEgY\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"city\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-50\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-HMkv_O2zrCtM\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Bundesland                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-HMkv_O2zrCtM\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"state\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-50\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-esNXGHcJC4Wa\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Bezirk                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-esNXGHcJC4Wa\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"zip_code\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-50\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-Oa7y-fBLmwBX\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Postleitzahl                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-Oa7y-fBLmwBX\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"zip_code-1\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-50\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-TOtu5O6cYEp7\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Ort                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-TOtu5O6cYEp7\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div><\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"email\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field formgent-field-width-100 formgent-field-email\">\n    <div class=\"formgent-field-single formgent-field-align-top formgent-field-single-email-primary\">\n                    <label\n                for=\"formgent-iV0HZhmo49Eb\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                E-Mail                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <div class='formgent-has-input-icon'>\n                \n                <input\n                    class=\"formgent-field-single__input\"\n                    type=\"email\"\n                    id=\"formgent-iV0HZhmo49Eb\"\n                    placeholder=\"\"\n                    data-wp-on--input=\"actions.updateInput\"\n                    data-wp-bind--value=\"state.getValue\"\n                \/>\n            <\/div>\n\n                    <\/div>\n    <\/div>\n\n    <\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"phone-number\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-single--csr formgent-field-align-top\">\n                    <label\n                for=\"formgent--Sx1BKWbqMnl\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Telefon                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div\n            class=\"formgent-field-single__wrapper\"\n        >\n            <div class=\"formgent-field-single__phone\">\n                <div class=\"formgent-field-single__dialer__content\">\n                    <input\n                        class=\"formgent-field-single__input \"\n                        type=\"tel\"\n                        id=\"formgent--Sx1BKWbqMnl\"\n                        placeholder=\"+43\"\n                        data-wp-init=\"callbacks.phoneNumberInit\"\n                    >\n                <\/div>\n            <\/div>\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"phone-number-1\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-single--csr formgent-field-align-top\">\n                    <label\n                for=\"formgent-PIzjJ4Bgef3F\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Telefon 2                            <\/label>\n                <div\n            class=\"formgent-field-single__wrapper\"\n        >\n            <div class=\"formgent-field-single__phone\">\n                <div class=\"formgent-field-single__dialer__content\">\n                    <input\n                        class=\"formgent-field-single__input \"\n                        type=\"tel\"\n                        id=\"formgent-PIzjJ4Bgef3F\"\n                        placeholder=\"+43\"\n                        data-wp-init=\"callbacks.phoneNumberInit\"\n                    >\n                <\/div>\n            <\/div>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice&quot;,&quot;field_label&quot;:&quot;Krankenkassen&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;RBLsc4v6zqrgj5LtMZ7e7&quot;,&quot;label&quot;:&quot;\\u00d6GK&quot;,&quot;value&quot;:&quot;gk&quot;},{&quot;id&quot;:&quot;t_o9eaUqE6zxpEHkt12Fn&quot;,&quot;label&quot;:&quot;BVAEB&quot;,&quot;value&quot;:&quot;bvaeb&quot;},{&quot;id&quot;:&quot;gsZGVoKrmiWGfAbgJveQ7&quot;,&quot;label&quot;:&quot;SVS&quot;,&quot;value&quot;:&quot;svs&quot;},{&quot;id&quot;:&quot;CZcEKXkTmZDPjP7MpRIo-&quot;,&quot;label&quot;:&quot;KFA&quot;,&quot;value&quot;:&quot;kfa&quot;},{&quot;id&quot;:&quot;ojA2qqLOxz-Otou5v14vk&quot;,&quot;label&quot;:&quot;Wahltherapie-Praxis&quot;,&quot;value&quot;:&quot;wahltherapie-praxis&quot;},{&quot;id&quot;:&quot;EjRaCbLOs0eRVzFxzS8I0&quot;,&quot;label&quot;:&quot;Patienten aus dem Ausland (EU)&quot;,&quot;value&quot;:&quot;patienten-aus-dem-ausland-eu&quot;},{&quot;id&quot;:&quot;NZd4UWCC2_tqt6hllSu6E&quot;,&quot;label&quot;:&quot;Wahlarztpraxis&quot;,&quot;value&quot;:&quot;wahlarztpraxis&quot;},{&quot;id&quot;:&quot;3Lgu73wN3eRTMcKQbyTOO&quot;,&quot;label&quot;:&quot;Privat&quot;,&quot;value&quot;:&quot;privat&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label for=\"formgent-multiple-choice\"\n                class=\"formgent-field-label formgent-label-align-top\">\n                Krankenkassen                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice formgent-field-single__box--two_columns\"\n                id=\"formgent-5BDOFWfhtVmq\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/template>\n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                            <\/div>\n\n                            <span class=\"formgent-field-sub-label\">\n                    Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice-1&quot;,&quot;field_label&quot;:&quot;Behandlungszielgruppe&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;vhMx2FgV0AqdTscmHd6Dw&quot;,&quot;label&quot;:&quot;Kleinkinder&quot;,&quot;value&quot;:&quot;kleinkinder&quot;},{&quot;id&quot;:&quot;uJuxozhlhbwlflsKUlAG0&quot;,&quot;label&quot;:&quot;Kinder und Jugendliche&quot;,&quot;value&quot;:&quot;kinder-und-jugendliche&quot;},{&quot;id&quot;:&quot;R_wIxNBrtz52-eErAt_MS&quot;,&quot;label&quot;:&quot;Erwachsene&quot;,&quot;value&quot;:&quot;erwachsene&quot;},{&quot;id&quot;:&quot;cwe8Lx9WXDLJlSqzKf18O&quot;,&quot;label&quot;:&quot;Neurogene Skoliosen&quot;,&quot;value&quot;:&quot;neurogene-skoliosen&quot;},{&quot;id&quot;:&quot;zN4aXRr8NAUYp9Uqx-L01&quot;,&quot;label&quot;:&quot;Idiopathische Skoliosen&quot;,&quot;value&quot;:&quot;idiopathische-skoliosen&quot;},{&quot;id&quot;:&quot;AodwJPNoLnNdt9T52nMUT&quot;,&quot;label&quot;:&quot;Postoperative Skoliosen&quot;,&quot;value&quot;:&quot;postoperative-skoliosen&quot;},{&quot;id&quot;:&quot;bwVIn6iEeP66XMcReSf3y&quot;,&quot;label&quot;:&quot;Korsetttr\\u00e4ger&quot;,&quot;value&quot;:&quot;korsetttr-ger&quot;},{&quot;id&quot;:&quot;other-formgent-h-pnSBx9Ih5N&quot;,&quot;label&quot;:&quot;Weitere&quot;,&quot;value&quot;:&quot;formgent_other&quot;,&quot;is_other&quot;:&quot;1&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label for=\"formgent-multiple-choice-1\"\n                class=\"formgent-field-label formgent-label-align-top\">\n                Behandlungszielgruppe                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice-1 formgent-field-single__box--two_columns\"\n                id=\"formgent-h-pnSBx9Ih5N\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/template>\n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ....\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                            <\/div>\n\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<h4 data-wp-bind--hidden=\"state.hideField\" data-wp-context=\"{ &quot;name&quot;: &quot;157aabD2BPbq7IO9tlNKZ&quot; }\" class=\"wp-block-heading display-none\"><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-green-cyan-color\">Mediale Pr\u00e4senz<\/mark><\/h4>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"website\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-942B1PDm6VDF\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                URL-Webseite (Premium** und VIP Paket***)                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"url\"\n                id=\"formgent-942B1PDm6VDF\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"website-1\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-GLJUZXAMN74C\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                YouTube (VIP Paket)***                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"url\"\n                id=\"formgent-GLJUZXAMN74C\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"website-2\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-Vx7sMMCpAd8V\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Facebook (VIP Paket)***                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"url\"\n                id=\"formgent-Vx7sMMCpAd8V\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"website-3\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-l5HYkA6JlpyX\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Instagram (VIP Paket)***                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"url\"\n                id=\"formgent-l5HYkA6JlpyX\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"text-4\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-67\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-xuZBhYU2Dn_C\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                \u00d6ffnungszeiten(VIP Paket)***                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-xuZBhYU2Dn_C\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice-11&quot;,&quot;field_label&quot;:&quot;Fachrichtung \\\/ Zusatzausbildungen&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;TxXuFnZE6ElwSAxJu5BR-&quot;,&quot;label&quot;:&quot;FA f\\u00fcr Orthop\\u00e4die und orthop\\u00e4dische Chirurgie&quot;,&quot;value&quot;:&quot;fa-f-r-orthop-die-und-orthop-dische-chirurgie&quot;},{&quot;id&quot;:&quot;7t7BzX4bDfjvGMyqNLVNF&quot;,&quot;label&quot;:&quot;FA f\\u00fcr Orthop\\u00e4die und Unfallchirurgie&quot;,&quot;value&quot;:&quot;fa-f-r-orthop-die-und-unfallchirurgie&quot;},{&quot;id&quot;:&quot;GaJygAUTYs9PkDCV2xLIg&quot;,&quot;label&quot;:&quot;FA f\\u00fcr Kinderorthop\\u00e4die&quot;,&quot;value&quot;:&quot;fa-f-r-kinderorthop-die&quot;},{&quot;id&quot;:&quot;0GpkY0jPFBpHU-8nw7AWv&quot;,&quot;label&quot;:&quot;FA f\\u00fcr Neurochirurgie&quot;,&quot;value&quot;:&quot;fa-f-r-neurochirurgie&quot;},{&quot;id&quot;:&quot;fyhkCYjOYbzRg-gYdl5zM&quot;,&quot;label&quot;:&quot;FA f\\u00fcr Neuroorthop\\u00e4die&quot;,&quot;value&quot;:&quot;fa-f-r-neuroorthop-die&quot;},{&quot;id&quot;:&quot;other-formgent-MNgYgRtMQWby&quot;,&quot;label&quot;:&quot;Weitere&quot;,&quot;value&quot;:&quot;formgent_other&quot;,&quot;is_other&quot;:&quot;1&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label for=\"formgent-multiple-choice-11\"\n                class=\"formgent-field-label formgent-label-align-top\">\n                Fachrichtung \/ Zusatzausbildungen                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice-11 formgent-field-single__box--two_columns\"\n                id=\"formgent-MNgYgRtMQWby\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/template>\n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                            <\/div>\n\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice-12&quot;,&quot;field_label&quot;:&quot;Orthop\\u00e4dische Leistungen und Behandlungsm\\u00f6glichkeiten bei Skoliose&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;Em6qxTzJnOpa_aIpDQhgK&quot;,&quot;label&quot;:&quot;Abkl\\u00e4rung und Diagnose &quot;,&quot;value&quot;:&quot;abkl-rung-und-diagnose&quot;},{&quot;id&quot;:&quot;gDM-2y9bzBIPFajUf628V&quot;,&quot;label&quot;:&quot;Konservative Therapie&quot;,&quot;value&quot;:&quot;konservative-therapie&quot;},{&quot;id&quot;:&quot;-ssBLJG933iY7_QMrXgvJ&quot;,&quot;label&quot;:&quot;Interventionelle Schmerztherapie&quot;,&quot;value&quot;:&quot;interventionelle-schmerztherapie&quot;},{&quot;id&quot;:&quot;CM1Kb_7HMq4X5sDpqaAQw&quot;,&quot;label&quot;:&quot;Neuromuskul\\u00e4re Skoliosen&quot;,&quot;value&quot;:&quot;neuromuskul-re-skoliosen&quot;},{&quot;id&quot;:&quot;HaF8ICflo88FS8yBps719&quot;,&quot;label&quot;:&quot;Skoliose \\\/ Kyphose \\\/ Lordose&quot;,&quot;value&quot;:&quot;skoliose-kyphose-lordose&quot;},{&quot;id&quot;:&quot;fj1vcKEdZHPi8h_Ar8Ren&quot;,&quot;label&quot;:&quot;Korsettversorgung Kinder und Jugendliche&quot;,&quot;value&quot;:&quot;korsettversorgung-kinder-und-jugendliche&quot;},{&quot;id&quot;:&quot;NX8ivBE89aTSLw5Jsh4CP&quot;,&quot;label&quot;:&quot;Korsettversorgung Erwachsene&quot;,&quot;value&quot;:&quot;korsettversorgung-erwachsene&quot;},{&quot;id&quot;:&quot;zTONvsDpwF-1zVqyVhU4d&quot;,&quot;label&quot;:&quot;Postoperative Skoliosen&quot;,&quot;value&quot;:&quot;postoperative-skoliosen&quot;},{&quot;id&quot;:&quot;a8Y8bOdNGqPSg2gdOnFxm&quot;,&quot;label&quot;:&quot;Postoperative Skoliosen nach Harrington&quot;,&quot;value&quot;:&quot;postoperative-skoliosen-nach-harrington&quot;},{&quot;id&quot;:&quot;kznzXUCpdsFIb4idWR1M-&quot;,&quot;label&quot;:&quot;Stabilisationsoperationen&quot;,&quot;value&quot;:&quot;stabilisationsoperationen&quot;},{&quot;id&quot;:&quot;other-formgent-7nXQpBS1dACB&quot;,&quot;label&quot;:&quot;Weitere&quot;,&quot;value&quot;:&quot;formgent_other&quot;,&quot;is_other&quot;:&quot;1&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label for=\"formgent-multiple-choice-12\"\n                class=\"formgent-field-label formgent-label-align-top\">\n                Orthop\u00e4dische Leistungen und Behandlungsm\u00f6glichkeiten bei Skoliose                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice-12 formgent-field-single__box--two_columns\"\n                id=\"formgent-7nXQpBS1dACB\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/template>\n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier eingeben\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                            <\/div>\n\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice-8&quot;,&quot;field_label&quot;:&quot;Zusatzleistungen&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;TAV8TPTrxDcwufSza1nqu&quot;,&quot;label&quot;:&quot;Online-Sprechstunde&quot;,&quot;value&quot;:&quot;online-sprechstunde&quot;},{&quot;id&quot;:&quot;other-formgent-_tfyV3g9DMjR&quot;,&quot;label&quot;:&quot;Weitere&quot;,&quot;value&quot;:&quot;formgent_other&quot;,&quot;is_other&quot;:&quot;1&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label for=\"formgent-multiple-choice-8\"\n                class=\"formgent-field-label formgent-label-align-top\">\n                Zusatzleistungen                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice-8 formgent-field-single__box--two_columns\"\n                id=\"formgent-_tfyV3g9DMjR\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/template>\n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Hier schreiben ...\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                            <\/div>\n\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"text-3\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-67\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-4LBqyGNw49BT\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Ordinationszeiten(VIP Paket)***                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-4LBqyGNw49BT\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<h3 data-wp-bind--hidden=\"state.hideField\" data-wp-context=\"{ &quot;name&quot;: &quot;05TXGI6FrbzAKn4x5bvHO&quot; }\" class=\"wp-block-heading display-none\"><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-green-cyan-color\">Anmerkungen und Hinweise<\/mark><\/h3>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"textarea\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                <div class=\"formgent-field-single__wrapper\">\n            <textarea\n                class=\"formgent-field-single__input formgent-field-single__input--textarea\"\n                type=\"text\"\n                id=\"formgent-KixVe-kLJN0e\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            ><\/textarea>\n                    <\/div>\n    <\/div>\n<\/div>\n\n\n<h3 data-wp-bind--hidden=\"state.hideField\" data-wp-context=\"{ &quot;name&quot;: &quot;VtdR-eTUFFu_axjfU5dJ-&quot; }\" class=\"wp-block-heading display-none\"><strong><mark style=\"background-color:rgba(0, 0, 0, 0)\" class=\"has-inline-color has-vivid-green-cyan-color\">Folgende Pakete stehen Ihnen zur Auswahl<\/mark><\/strong><\/h3>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice-5&quot;,&quot;field_label&quot;:&quot;Bitte w\\u00e4hlen Sie hier das passendes Paket f\\u00fcr Ihre Eintragung aus&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;P8Iu7kycV4o_NlBVgVif7&quot;,&quot;label&quot;:&quot;Basis-Paket - Kostenlos*&quot;,&quot;value&quot;:&quot;paket-xs-150-00-j-hrlich-u-strong-nd-auch-strong-ihre-patient-innen-profitieren-davon&quot;,&quot;isCustomValue&quot;:&quot;1&quot;,&quot;collapsed&quot;:&quot;1&quot;},{&quot;id&quot;:&quot;pu002du002dqy7YOoPnwANRnXi2n4&quot;,&quot;label&quot;:&quot;Premium-Paket - 50\\u20ac (J\\u00e4hrliche Abrechnung) **&quot;,&quot;value&quot;:&quot;premium-paket-50-j-hrliche-abrechnung&quot;},{&quot;id&quot;:&quot;iI8SqQzszqm6A4hIR06Xl&quot;,&quot;label&quot;:&quot;VIP-Paket - 170\\u20ac (J\\u00e4hrliche Abrechnung) ***&quot;,&quot;value&quot;:&quot;vip-paket-170-j-hrliche-abrechnung&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label for=\"formgent-multiple-choice-5\"\n                class=\"formgent-field-label formgent-label-align-top\">\n                Bitte w\u00e4hlen Sie hier das passendes Paket f\u00fcr Ihre Eintragung aus                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice-5 formgent-field-single__box--full_width\"\n                id=\"formgent-eoQC5YxgDzHx\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/template>\n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                            <\/div>\n\n                            <span class=\"formgent-field-sub-label\">\n                    *<strong>Basis-Paket:<\/strong>\u00a0Ihre Kontaktdate, Behandlungszielgruppe, Leistungen werden Ihrem Eintrag hinzugef\u00fcgt.<br><br>**<strong>Premium-Paket<\/strong>: Neben dem Basis-Paket wird Ihrem Profil ein Portraitfoto\u00a0<strong>oder<\/strong>\u00a0Logo hinzugef\u00fcgt, sowie eine Verlinkung zu Ihrer Praxis-Website. Dar\u00fcber hinaus erhalten Sie einen Rabattcode in Form von Rabattkarten, der Ihren Patienten einen Rabatt von 25 % in unserem Online-Shop (ausgenommen Aktionsware) gew\u00e4hrt.<br><br><strong>***VIP-Paket:<\/strong>\u00a0Zus\u00e4tzlich zu den Leistungen des Premium-Pakets bieten wir Ihnen die M\u00f6glichkeit, Ihr Portraitfoto, Ihr Unternehmenslogo sowie Bild- und Videodateien oder eine Unternehmensanzeige einzuf\u00fcgen. Zudem besteht die Option, einen Blogbeitrag \u00fcber Ihr Leistungsangebot, Ihre T\u00e4tigkeit oder ein Thema im Zusammenhang mit Skoliose zu verfassen. Dar\u00fcber hinaus wird Ihr Praxislogo oder Ihre Unternehmensanzeige als Banner auf der Startseite des Skoliose Netzwerks \u00d6sterreich und in der Expertensuche angezeigt.\u00a0<em>Weiters wird Ihr Eintrag mit Ihrer Praxis-Homepage sowie Ihren Profilen auf Facebook, Instagram und YouTube verlinkt, sofern diese vorhanden sind.<\/em>\u00a0<em>Zus\u00e4tzlich erhalten Sie einen Rabattcode in Form von Rabattkarten, der Ihren Patienten einen Rabatt von 30 % in unserem Online-Shop (ausgenommen Aktionsware) gew\u00e4hrt.<\/em>\u00a0Weitere Informationen zum VIP-Paket erfahren Sie<mark>\u00a0<strong><a href=\"https:\/\/www.skoliosenetzwerkoesterreich.at\/fuer-experten-2\/\">hier<\/a><\/strong><\/mark><strong>.<\/strong>                <\/span>\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n<style>\n        .formgent-upload-container {\n            min-height: 150px;\n            display: flex;\n            align-items: center;\n            justify-content: center;\n            flex-direction: column;\n            cursor: pointer;\n            border-radius: 8px;\n            border: 1px dashed var(--formgent-color-gray-300);\n            background: var(--formgent-field-background-color);\n            width: 100%;\n            padding: 20px;\n            text-align: center;\n        }\n        .formgent-upload-container .formgent-upload-area {\n            border: 0 none;\n        }\n        .formgent-upload-container p {\n            color: var(--formgent-field-placeholder-color);\n            text-align: center;\n            font-size: 14px;\n            font-weight: 400;\n            line-height: 1.6;\n            margin: 8px 0 0 0;\n        }\n        .formgent-upload-button {\n            display: inline-flex;\n            padding: 8px 12px;\n            justify-content: center;\n            align-items: center;\n            gap: 6px;\n            border-radius: 8px;\n            background: var(--formgent-color-gray-500, #747c89);\n            cursor: pointer;\n            color: #fff;\n            text-align: center;\n            font-size: 13px;\n            font-weight: 500;\n            transition: 0.3s ease;\n            border: 0 none;\n            box-shadow: none;\n        }\n    <\/style>\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{\"name\":\"file-upload-1\",\"highlightFileUpload\":false,\"uploadedFiles\":[],\"maxSizeError\":false,\"maxFileError\":false,\"maxAllowed\":5,\"notAllowed\":false,\"maxAllowedReached\":false}' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-single--file-upload formgent-field-align-top\">\n                    <span\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Hochladen von Bilddateien \/ Portraitfoto \/  Logo \/ Unternehmensanzeige, Video, Textdokumente (Premium und VIP Paket)**\/***                            <\/span>\n                <div\n            class=\"formgent-upload-container\"\n        >\n            <label aria-disabled=\"false\"\n                for=\"formgent-O2M6xChDW5_r\"\n                class=\"formgent-upload-area\"\n                tabindex=\"0\"\n                role=\"button\"\n                aria-label=\"Upload\"\n                data-wp-class--formgent-file-upload-highlight=\"context.highlightFileUpload\"\n                data-wp-class--formgent-file-upload-disabled=\"context.maxAllowedReached\"\n                data-wp-bind--aria-disabled=\"context.maxAllowedReached\"\n                data-wp-on--dragenter=\"actions.fileDragEnter\"\n                data-wp-on--dragover=\"actions.fileDragEnter\"\n                data-wp-on--dragleave=\"actions.fileDragLeave\"\n                data-wp-on--drop=\"actions.fileDrop\"\n                data-wp-on--keydown=\"actions.handleUploadAreaKeydown\"\n            >\n                <span class=\"formgent-upload-button\">\n                    <svg width=\"14\" height=\"14\" viewBox=\"0 0 14 14\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n<path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0.333252 1.00016C0.333252 0.631973 0.631729 0.333496 0.999919 0.333496H12.9999C13.3681 0.333496 13.6666 0.631973 13.6666 1.00016C13.6666 1.36835 13.3681 1.66683 12.9999 1.66683H0.999919C0.631729 1.66683 0.333252 1.36835 0.333252 1.00016ZM6.99992 3.00016C7.17673 3.00016 7.3463 3.0704 7.47132 3.19542L11.4713 7.19543C11.7317 7.45577 11.7317 7.87788 11.4713 8.13823C11.211 8.39858 10.7889 8.39858 10.5285 8.13823L7.66659 5.27631V13.0002C7.66659 13.3684 7.36811 13.6668 6.99992 13.6668C6.63173 13.6668 6.33325 13.3684 6.33325 13.0002V5.27631L3.47132 8.13823C3.21097 8.39858 2.78886 8.39858 2.52851 8.13823C2.26816 7.87788 2.26816 7.45577 2.52851 7.19543L6.52851 3.19542C6.65354 3.0704 6.82311 3.00016 6.99992 3.00016Z\" fill=\"currentColor\"\/>\n<\/svg>\n                    Upload                <\/span>\n                <input\n                    multiple\n                    type=\"file\"\n                    class=\"formgent-file-input\"\n                    style=\"display: none;\"\n                    id=\"formgent-O2M6xChDW5_r\"\n                    data-wp-on--change=\"actions.onChangeFile\"\n                    data-wp-bind--disabled=\"context.maxAllowedReached\"\n                \/>\n\n                <!-- Hidden validation input for required field validation -->\n                <input\n                    type=\"hidden\"\n                    class=\"formgent-validate-field-input\"\n                    name=\"file-upload-1\"\n                    value=\"\"\n                \/>\n\n                <p>Datei hier herziehen oder zum Hochladen klicken. Maximal zul\u00e4ssige Dateigr\u00f6\u00dfe: <\/p>\n\n                                    <p> 250KB<\/p>\n                \n                            <\/label>\n\n            <span hidden class=\"formgent-warning-message\" data-wp-bind--hidden=\"!context.maxSizeError\">\n                 250KB            <\/span>\n            <span hidden class=\"formgent-warning-message\" data-wp-bind--hidden=\"!context.maxFileError\">\n                Maximum number of files allowed: 5            <\/span>\n            <span hidden class=\"formgent-warning-message\" data-wp-bind--hidden=\"!context.notAllowed\">\n                File type not allowed. Allowed file types: image\/jpeg, image\/png, application\/pdf            <\/span>\n\n\n            <div hidden class=\"formgent-file-preview\" data-wp-bind--hidden=\"!state.hasFiles\">\n                <ul class=\"formgent-preview-items\">\n                    <template data-wp-each=\"context.uploadedFiles\">\n                        <li class=\"formgent-preview-container\">\n                            <div class=\"formgent-file-preview-media\">\n                                <div>\n                                    <img\n                                        data-wp-bind--hidden=\"!context.item.isImage\"\n                                        class=\"formgent-preview-image\"\n                                        data-wp-bind--src=\"context.item.src\"\n                                    \/>\n                                    <video\n                                        data-wp-bind--hidden=\"!context.item.isVideo\"\n                                        class=\"formgent-preview-image\"\n                                        width=\"120\"\n                                        height=\"100\"\n                                    >\n                                        <source data-wp-bind--src=\"context.item.src\">\n                                    <\/video>\n                                    <span data-wp-bind--hidden=\"!context.item.isOther\">\n                                                                            <\/span>\n                                <\/div>\n                                <p class=\"formgent-file-name\">\n                                    <span data-wp-text=\"context.item.name\"><\/span><br\/>\n                                    <span data-wp-text=\"context.item.size\"><\/span>\n                                <\/p>\n                                <div\n                                    data-wp-bind--hidden=\"context.item.uploaded\"\n                                    class=\"formgent-file-preview-status\"\n                                >\n                                    <span\n                                        data-wp-style----formgent-file-upload-progress=\"context.item.progress\"\n                                        class=\"formgent-file-upload-progress\"\n                                    ><\/span>\n                                    <span\n                                        data-wp-text=\"context.item.progress\"\n                                        class=\"formgent-file-upload-progress-text\"\n                                    >\n                                        0%\n                                    <\/span>\n                                <\/div>\n                            <\/div>\n                            <div data-wp-bind--hidden=\"!context.item.uploaded\" class=\"formgent-file-preview-action\">\n                                <span\n                                    class=\"formgent-file-delete\"\n                                    tabindex=\"0\"\n                                    role=\"button\"\n                                    aria-label=\"Delete file\"\n                                    data-wp-on--click=\"actions.removeFile\"\n                                    data-wp-on--keydown=\"actions.handleRemoveFileKeydown\"\n                                >\n                                    <svg width=\"100%\" height=\"100%\" viewBox=\"0 0 24 24\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\">\n <path d=\"M16 6V5.2C16 4.0799 16 3.51984 15.782 3.09202C15.5903 2.71569 15.2843 2.40973 14.908 2.21799C14.4802 2 13.9201 2 12.8 2H11.2C10.0799 2 9.51984 2 9.09202 2.21799C8.71569 2.40973 8.40973 2.71569 8.21799 3.09202C8 3.51984 8 4.0799 8 5.2V6M10 11.5V16.5M14 11.5V16.5M3 6H21M19 6V17.2C19 18.8802 19 19.7202 18.673 20.362C18.3854 20.9265 17.9265 21.3854 17.362 21.673C16.7202 22 15.8802 22 14.2 22H9.8C8.11984 22 7.27976 22 6.63803 21.673C6.07354 21.3854 5.6146 20.9265 5.32698 20.362C5 19.7202 5 18.8802 5 17.2V6\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"\/>\n <\/svg>\n                                <\/span>\n                            <\/div>\n                        <\/li>\n                    <\/template>\n                <\/ul>\n            <\/div>\n        <\/div>\n    <\/div>\n            <span class=\"formgent-field-sub-label\">\n            Bitte senden Sie uns Bilddateien (Logo, Unternehmensanzeige, Portraitbild etc.) f\u00fcr Ihren Eintrag im JPG- oder PNG-Format.\u00a0        <\/span>\n    <\/div>\n\n\n\n<h5 data-wp-bind--hidden=\"state.hideField\" data-wp-context=\"{ &quot;name&quot;: &quot;DaJL0lzll47NoGLTXZLu4&quot; }\" class=\"wp-block-heading has-text-align-center display-none\">Das Premium- und VIP-Paket stellt einen j\u00e4hrlichen Beitrag dar. Die Mindestvertragslaufzeit betr\u00e4gt 12 Monate. Nach Ablauf dieser Frist verl\u00e4ngert sich der Vertrag automatisch auf unbestimmte Zeit und kann jederzeit schriftlich per E-Mail oder Post mit einer K\u00fcndigungsfrist von 4 Wochen gek\u00fcndigt werden.<\/h5>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice-6&quot;,&quot;field_label&quot;:&quot;Bitte w\\u00e4hlen Sie hier aus, wie die Rechnung f\\u00fcr das von Ihnen gew\\u00e4hlte Paket \\u00fcbermittelt werden soll:&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;d0RGSlBBgjFrEiU3vk8FV&quot;,&quot;label&quot;:&quot;Per Postweg&quot;,&quot;value&quot;:&quot;per-postweg&quot;},{&quot;id&quot;:&quot;other-formgent-ZfXTyLlUVEi9&quot;,&quot;label&quot;:&quot;Per E-Mail&quot;,&quot;value&quot;:&quot;formgent_other&quot;,&quot;is_other&quot;:&quot;1&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-justify\">\n                    <label for=\"formgent-multiple-choice-6\"\n                class=\"formgent-field-label formgent-label-align-justify\">\n                Bitte w\u00e4hlen Sie hier aus, wie die Rechnung f\u00fcr das von Ihnen gew\u00e4hlte Paket \u00fcbermittelt werden soll:                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice-6 formgent-field-single__box--full_width\"\n                id=\"formgent-ZfXTyLlUVEi9\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/template>\n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                            <\/div>\n\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-init=\"callbacks.initSelectField\"\n    data-wp-context='{&quot;name&quot;:&quot;multiple-choice-7&quot;,&quot;field_label&quot;:&quot;Informationspaket f\\u00fcr Ihre Praxis&quot;,&quot;options&quot;:[{&quot;id&quot;:&quot;CPSIQRPgKl_tCoUHmdnYW&quot;,&quot;label&quot;:&quot;Bitte senden Sie mir ein Informationspaket an meine Praxisadresse. Beinhaltet 20 Infoflyer, 5 Fr\\u00fcherkennungsbrosch\\u00fcren und ein Reiskissen.&quot;,&quot;value&quot;:&quot;bitte-senden-sie-mir-ein-informationspaket-an-meine-praxisadresse-beinhaltet-20-infoflyer-5-fr-herkennungsbrosch-ren-und-ein-reiskissen&quot;}],&quot;field_type&quot;:&quot;multiple-choice&quot;}'\n    data-wp-bind--hidden=\"state.hideField\"\n    class=\"display-none formgent-field formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label for=\"formgent-multiple-choice-7\"\n                class=\"formgent-field-label formgent-label-align-top\">\n                Informationspaket f\u00fcr Ihre Praxis                            <\/label>\n                <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--multi-choice\">\n            <div class=\"formgent-field-single__box formgent-multiple-choice-multiple-choice-7 formgent-field-single__box--full_width\"\n                id=\"formgent-rAgXFdanJ6py\"\n                data-wp-init=\"callbacks.multipleChoiceKeyboard\">\n                                    <template data-wp-each--option=\"context.options\">\n                        <div\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    <\/template>\n                        <div data-wp-each-child=\"formgent\/form::context.options\"\n                            class=\"formgent-field-single__box__choice formgent-field-single__box__choice--frame\">\n                            <input class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                                type=\"checkbox\" data-wp-on--change=\"actions.updateMultiChoice\"\n                                data-wp-bind--id=\"state.getOptionId\"\n                                data-wp-bind--checked=\"state.isMultiSelectOptionChecked\"\n                                data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                data-wp-bind--name=\"state.getOptionName\" \/>\n                            <label data-wp-bind--for=\"state.getOptionId\" class=\"formgent-field-single__label\">\n                                <span class=\"formgent-field-single__checkbox\">\n                                                                    <\/span>\n                                <span data-wp-text=\"state.getOptionLabel\"><\/span>\n                                <input hidden type=\"text\" class=\"formgent-field-other-input\"\n                                    data-wp-bind--hidden=\"!context.option.is_other\"\n                                    data-wp-bind--disabled=\"state.isMultiSelectOptionDisabled\"\n                                    data-wp-bind--value=\"state.getOtherOptionValue\"\n                                    data-wp-on--input=\"actions.updateMultiSelectSpecify\"\n                                    placeholder=\"Please specify\" \/>\n                            <\/label>\n                        <\/div>\n                    \n                            <\/div>\n\n                    <\/div>\n    <\/div>\n\n    <!-- <div data-wp-bind--hidden=\"!state.showFieldQuantityInput\" class=\"formgent-field-single formgent-field-quantity\" data-wp-class--formgent-field-quantity-hidden=\"!state.showFieldQuantityInput\">\n        <label for=\"\"\n            class=\"formgent-field-label\" data-wp-text=\"state.getQuantityLabel\">\n        <\/label>\n        <input class=\"formgent-field-single__input\" type=\"number\"\n            id=\"\"\n            name=\"_quantity\"\n            data-wp-on--input=\"actions.updatePaymentQuantity\"\n            data-wp-bind--value=\"state.getFieldQuantity\"\n            data-wp-bind--min=\"state.getFieldQuantityMin\"\n            data-wp-bind--max=\"state.getFieldQuantityMax\"\n            value=\"1\" \/>\n    <\/div> -->\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"gdpr\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single\">\n        <div class=\"formgent-field-single__wrapper formgent-field-single__wrapper--gdpr formgent-label-align-left\">\n            <input\n                class=\"formgent-field-single__input formgent-field-single__input--checkbox\"\n                type=\"checkbox\"\n                id=\"formgent-k_arq4LacaHV\"\n                data-wp-on--change=\"actions.updateGdpr\"\n                data-wp-bind--checked=\"state.getValue\"\n            \/>\n            <label for=\"formgent-k_arq4LacaHV\" class=\"formgent-field-label\">\n                <span class=\"formgent-field-gdpr-checkbox\">\n                                    <\/span>\n                <span class=\"formgent-field-sub-label\">\n                    Ich stimme den Bestimmungen der DSGVO zu.                    <span class=\"formgent-field-required\">*<\/span>\n                <\/span>\n            <\/label>\n        <\/div>\n    <\/div>\n<\/div>\n\n\n<div data-wp-interactive=\"formgent\/form\" data-wp-context='{ \"name\": \"text\" }' data-wp-bind--hidden=\"state.hideField\" class=\"display-none formgent-field   formgent-field-width-100\">\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-2KRCErZjPMrf\"\n                class= \"formgent-field-label formgent-label-align-top\"\n            >\n                Mit dem Absenden best\u00e4tige ich, dass ich den allgemeinen Vertragsbedingungen des SN\u00d6 zustimme.                                    <span class=\"formgent-field-required\">\n                        *\n                    <\/span>\n                            <\/label>\n                <div class=\"formgent-field-single__wrapper\">\n            <input\n                class=\"formgent-field-single__input\"\n                type=\"text\"\n                id=\"formgent-2KRCErZjPMrf\"\n                placeholder=\"\"\n                data-wp-on--input=\"actions.updateInput\"\n                data-wp-bind--value=\"state.getValue\"\n            \/>\n                            <span class=\"formgent-field-sub-label\">\n                    Ort, Datum - Pflichtfeld                <\/span>\n                    <\/div>\n    <\/div>\n<\/div>\n\n<div \n    data-wp-interactive=\"formgent\/form\" \n    data-wp-context='{\"name\":\"captcha\",\"field_type\":\"range-slider\",\"slider_type\":\"number\",\"text_options\":[{\"id\":\"option_1\",\"label\":\"Option 1\",\"value\":\"option_1\"},{\"id\":\"option_2\",\"label\":\"Option 2\",\"value\":\"option_2\"},{\"id\":\"option_3\",\"label\":\"Option 3\",\"value\":\"option_3\"}],\"sliderState\":{\"value\":0,\"valueLabel\":\"\"}}' \n    data-wp-bind--hidden=\"state.hideField\" \n    class=\"display-none formgent-field formgent-field-width-50\"\n    data-wp-init=\"callbacks.initRangeSlider\"\n>\n    <div class=\"formgent-field-single formgent-field-align-top\">\n                    <label\n                for=\"formgent-VCNOv52mkyl1\"\n                class=\"formgent-field-label formgent-label-align-top\"\n            >\n                Captcha: Ergebnis aus f\u00fcnf mal 6 =                     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<\/form>\n\n<\/div>\n\n\n","protected":false},"author":1,"template":"","meta":{"_formgent_fields":[],"_formgent_page_break_settings":{"next_button_style":"default","next_button_bg_color":"#4cafaa","next_button_border_color":"#000000","next_button_text_color":"#000000","back_button_style":"default","back_button_bg_color":"#4cafaa","back_button_border_color":"#000000","back_button_text_color":"#000000","progress_indicator":"progress_bar","show_labels":true},"_formgent_form_settings":{"toggle_form_type":false,"form_background":"color","form_background_color":"#ffffff","form_background_image":[],"form_padding":[],"form_margin":[],"form_border":[],"field_border":{"border":{"width":"1px","style":"solid","color":"#d2d6db"},"radius":{"topLeft":"8px","topRight":"8px","bottomRight":"8px","bottomLeft":"8px"}},"field_colors":{"background":{"default":"transparent","hover":"transparent"},"placeholder":{"default":"#a1a9b2"},"label":{"default":"#000000"},"description":{"default":"#747c89"},"error":{"default":"#c83a3a"},"input_color":{"default":"#4d5761"},"options_color":{"default":"#4d5761"},"rating_color":{"default":"#a1a9b2","hover":"#5e53f9"},"range_slider_color":{"default":"#000000"}},"field_horizontal_spacing":{"desktop":"12px","tablet":"12px","mobile":"12px"},"field_vertical_spacing":{"desktop":"35px","tablet":"35px","mobile":"35px"},"show_page_break_labels":"","page_break_progress_indicator":"none","next_button_style":"default","next_button_bg_color":"#000000","next_button_text_color":"#ffffff","next_button_border_color":"#000000","back_button_style":"default","back_button_bg_color":"#000000","back_button_text_color":"#ffffff","back_button_border_color":"#000000","submit_button_alignment":"left","submit_button_style":"default","submit_button_background_color":"#000000","submit_button_border_color":"#000000","submit_button_text_color":"#ffffff","submit_button_label":"Submit","submit_button_disabled":false,"use_label_as_placeholder":false,"switch_to_conversational":false},"_formgent_type":"general","_formgent_pending_type_migration":""},"class_list":["post-4615","formgent_form","type-formgent_form","status-publish","hentry"],"yoast_head":"<!-- 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