{"url":"\/rezept-ueberweisung","form_action_on_submit":"display_text","form_action_on_submit_text":"Liebe Patientien, lieber Patient,<br><\/br>\n\nVielen Dank f\u00fcr die Nutzung unseres Online-Service.<br><\/br>\nUnser Praxisteam k\u00fcmmert sich sehr gerne um Ihr Anliegen.\n<br><\/br>\nSollte ein pers\u00f6nlicher Besuch bei Frau Dr. Baumann oder Herrn Dr. Misch erforderlich sein, werden wir Sie umgehend benachrichtigen.\n<br><\/br>\nIhr Dr. med Christoph Misch + Team\n<br>\nLange Stra\u00dfe 80 | 76879 Ottersheim<br><\nTelefon 0 63 48 \/ 64 00","rows":[{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-16","field_name":"Vorname","field_type":"firstname","field_label":"Vorname (Pflichtfeld)","field_placeholder":"Vorname","clientField":"firstname","field_required":"1","field_label_required_error":"","field_hidden":null}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-15","field_name":"Nachname","field_type":"lastname","field_label":"Nachname (Pflichtfeld)","field_placeholder":"Nachname","clientField":"lastname","field_required":"1","field_label_required_error":"","field_hidden":null}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-14","field_name":"E-Mail","field_type":"email","field_label":"E-Mail (Pflichtfeld)","field_placeholder":"E-Mail","clientField":"email","field_required":"1","field_label_required_error":"","field_hidden":null}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-12","field_name":"E-Mail wiederholen","field_type":"repeat_email","field_label":"E-Mail wiederholen (Pflichtfeld)","field_placeholder":"E-Mail wiederholen","clientField":"repeat_email","field_required":"1","field_label_required_error":"","field_hidden":null,"field_label_email_does_not_match_error":""}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-11","field_name":"Auswahl","field_type":"checkbox","field_label":"Bitte ausw\u00e4hlen (Mehrfachauswahl m\u00f6glich)","field_placeholder":"Rezeptbestellung (wird digital zugestellt)","field_required":null,"field_label_required_error":"","field_hidden":null,"field_select_multiple":null,"field_label_no_option":"","options":[{"option_label":"Rezeptbestellung (wird digital zugestellt)","option_value":"","option_selected":false},{"option_label":"\u00dcberweisungswunsch (zur Abholung in der Praxis)","option_value":"","option_selected":false}]}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-10","field_name":"Datei Upload","field_type":"input_file","field_label":"Datei Upload","field_placeholder":"Bild\/Dokument hochladen","field_required":null,"field_label_required_error":"","field_hidden":null,"field_label_choose_file":""}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-9","field_name":"Rezept anfordern","field_type":"textarea","field_label":"Rezept anfordern","field_placeholder":"Bitte genaue Bezeichnung des gew\u00fcnschten Medikaments \/ der Medikamente hier eintragen","field_required":null,"field_label_required_error":"","field_hidden":null}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-8","field_name":"\u00dcberweisung anfordern","field_type":"textarea","field_label":"\u00dcberweisung","field_placeholder":"Name des Arztes \/ Therapeuten \/ Fachgebiet hier bitte eintragen","field_required":null,"field_label_required_error":"","field_hidden":null}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-7","field_name":"Textfeld","field_type":"textarea","field_label":"Platz f\u00fcr Ihre Info an die Praxis am Eck","field_placeholder":"optional","field_required":null,"field_label_required_error":"","field_hidden":null}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-6","field_name":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-6","field_type":"text","text":"<p class=\"p-small\">Ja, ich habe die <u><a href=\"\/datenschutz\" target=\"_blank\" title=\"Datenschutzerkl\u00e4rung der Praxis am Eck in Ottersheim\">Datenschutzerkl\u00e4rung<\/a><\/u> zur Kenntnis genommen und bin damit einverstanden, dass die von mir angegebenen Daten elektronisch erhoben und gespeichert werden. Meine Daten werden dabei nur streng zweckgebunden zur Bearbeitung und Beantwortung meiner Anfrage genutzt.<\/p>"}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-4","field_name":"Einwilligungsfeld Datenschutz","field_type":"checkbox","field_label":"Einwilligungserkl\u00e4rung Datenschutz","field_placeholder":"Bitte anklicken (Pflichtfeld)","field_required":"1","field_label_required_error":"Pflichtfeld","field_hidden":null,"field_select_multiple":null,"field_label_no_option":"","options":[{"option_label":"Bitte anklicken","option_value":"","option_selected":false}]}]}]},{"columns":[{"columnWidth":null,"fields":[{"field_id":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-1","field_name":"3ad4165c-031c-468d-b9db-3b1bf1b2c755-field-1","field_type":"button","field_label":"Absenden","field_placeholder":"","field_required":null,"field_label_required_error":"","field_hidden":null,"field_value":"","field_button_size":"inherit_form","field_button_custom_size":"1","field_button_style":"inherit","field_button_shape":"inherit","field_button_padding_vertical":"0.85","field_button_padding_horizontal":"1.65","buttonClasses":"wsw-block-button-default wsw-button-solid wsw-button-rounded wsw-button-medium wsw-button-custom-padding"}]}]}]}

{"no_option":"Keine Option","subscribe_to_newsletter":"Newsletter abonnieren","subscribe_to_newsletter_yes":"Ja","subscribe_to_newsletter_no":"Nein","choose_file":"Datei ausw\u00e4hlen","invalid_email":"E-Mail ist nicht korrekt","email_does_not_match":"E-Mail stimmt nicht \u00fcberein","password_does_not_match":"Passwort stimmt nicht \u00fcberein","captcha_failed":"Captcha-Verifikation fehlgeschlagen. Bitte versuchen Sie es erneut.","field_required":"Dieses Feld ist notwendig","unknown_error":"Unbekannter Error. Bitte neu laden","on_submit_text":"Vielen Dank f\u00fcr das Einreichen des Formulars."}