{"id":14814,"date":"2023-06-21T13:39:05","date_gmt":"2023-06-21T11:39:05","guid":{"rendered":"https:\/\/skinbyzer.be\/?page_id=14814"},"modified":"2023-06-21T13:39:49","modified_gmt":"2023-06-21T11:39:49","slug":"intakeformulier","status":"publish","type":"page","link":"https:\/\/skinbyzer.be\/fr\/intakeformulier\/","title":{"rendered":"Intakeformulier"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"14814\" class=\"elementor elementor-14814\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5defee2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"5defee2\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ebb9d2f\" data-id=\"ebb9d2f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ede3dd5 elementor-widget elementor-widget-shortcode\" data-id=\"ede3dd5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class='fluentform ff-default fluentform_wrapper_4 ffs_default_wrap'><form data-form_id=\"4\" id=\"fluentform_4\" class=\"frm-fluent-form fluent_form_4 ff-el-form-top ff_form_instance_4_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_4_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Gezichtsbehandelingen NL<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='14814' \/><input type=\"hidden\" id=\"_fluentform_4_fluentformnonce\" name=\"_fluentform_4_fluentformnonce\" value=\"9c4c59893f\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/14814\" \/><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_1\" ><p><span style=\"text-decoration: underline\"><strong>Persoonlijke gegevens<\/strong><\/span><\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_multi_select_6' id='label_ff_4_multi_select_6'>Keuze van behandeling<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_6[]\" id=\"ff_4_multi_select_6\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_6\" data-max_selected_options=\"1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_4_multi_select_6\"><option value=\"Skin Analyse \/ Meet &amp; Treat\"  >Skin Analyse \/ Meet & Treat<\/option><option value=\"Microneedling\"  >Microneedling<\/option><option value=\"Chemische peeling\"  >Chemische peeling<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_12' id='label_ff_4_input_text_12'>Datum van de behandeling \/ afspraak <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_12\" class=\"ff-el-form-control\" placeholder=\"bv: 01 januari 2023\" data-name=\"input_text_12\" id=\"ff_4_input_text_12\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_first_name_' id='label_ff_4_names_first_name_'>Voornaam<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_4_names_first_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_last_name_' id='label_ff_4_names_last_name_'>Achternaam<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_4_names_last_name_\" class=\"ff-el-form-control\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_address_line_1_' id='label_ff_4_address_1_address_line_1_'>Adres<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_4_address_1_address_line_1_\" class=\"ff-el-form-control\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_2\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_address_2_zip_' id='label_ff_4_address_2_zip_'>Postcode<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_2[zip]\" id=\"ff_4_address_2_zip_\" class=\"ff-el-form-control\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_3\" ><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_address_3_city_' id='label_ff_4_address_3_city_'>Stad<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_3[city]\" id=\"ff_4_address_3_city_\" class=\"ff-el-form-control\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names_1\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_1_first_name_' id='label_ff_4_names_1_first_name_'>Telefoonnummer<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_4_names_1_first_name_\" class=\"ff-el-form-control\" placeholder=\"Telefoonnummer\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_email' id='label_ff_4_email'>Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_4_email\" class=\"ff-el-form-control\" placeholder=\"Voorbeeld@hotmail.com\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_input_text_11' id='label_ff_4_input_text_11'>Geboortedatum<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_11\" class=\"ff-el-form-control\" placeholder=\"bv: 01 januari 1996\" data-name=\"input_text_11\" id=\"ff_4_input_text_11\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_2\" ><p><span style=\"text-decoration: underline\"><strong>Medische gegevens\u00a0<\/strong><\/span><\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_description' id='label_ff_4_description'>Bent u in behandeling bij een arts? <\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_4_description\" name=\"description\" id=\"ff_4_description\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_multi_select_1' id='label_ff_4_multi_select_1'>Gebruikt u medicijnen?<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_1[]\" id=\"ff_4_multi_select_1\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_1\" data-max_selected_options=\"1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_4_multi_select_1\"><option value=\"Ja \"  >Ja<\/option><option value=\"Neen\"  >Neen<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_1' id='label_ff_4_input_text_1'>Indien u medicijnen gebruikt, welke zijn dat? <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_4_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_2' id='label_ff_4_input_text_2'>Welke verzorgingsproducten gebruikt u? <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_4_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_input_text_3' id='label_ff_4_input_text_3'>Bent u allergisch voor bepaalde producten? <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_3\" class=\"ff-el-form-control\" data-name=\"input_text_3\" id=\"ff_4_input_text_3\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_multi_select_2' id='label_ff_4_multi_select_2'>Hebt u last van \u00e9\u00e9n van de volgende huidaandoeningen?<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_2[]\" id=\"ff_4_multi_select_2\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_2\" data-max_selected_options=\"6\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_multi_select_2\"><option value=\"Acn\u00e9\"  >Acn\u00e9<\/option><option value=\"Psoriasis\"  >Psoriasis<\/option><option value=\"Melanoom\"  >Melanoom<\/option><option value=\"Herpes\"  >Herpes<\/option><option value=\"Littekens\"  >Littekens<\/option><option value=\"Bloedvatafwijkingen\"  >Bloedvatafwijkingen<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_4' id='label_ff_4_input_text_4'>Andere huidaandoening namelijk: <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" data-name=\"input_text_4\" id=\"ff_4_input_text_4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_multi_select_3' id='label_ff_4_multi_select_3'>Onderging u \u00e9\u00e9n van de volgende behandelingen tijdens de 3 laatste weken?  <\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_3[]\" id=\"ff_4_multi_select_3\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_3\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_multi_select_3\"><option value=\"Harsen\"  >Harsen<\/option><option value=\"Laser\"  >Laser<\/option><option value=\"IPL\"  >IPL<\/option><option value=\"Gezichtsimplantaten\"  >Gezichtsimplantaten<\/option><option value=\"Fillers\/Botox\"  >Fillers\/Botox<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_multi_select_4' id='label_ff_4_multi_select_4'>Heeft u de volgende klachten\/aandoeningen:<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_4[]\" id=\"ff_4_multi_select_4\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_4\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_multi_select_4\"><option value=\"Zwanger\"  >Zwanger<\/option><option value=\"Borstvoeding\"  >Borstvoeding<\/option><option value=\"Hartproblemen\"  >Hartproblemen<\/option><option value=\"Hoge bloeddruk\"  >Hoge bloeddruk<\/option><option value=\"Lage bloeddruk\"  >Lage bloeddruk<\/option><option value=\"Diabetes\"  >Diabetes<\/option><option value=\"Epilepsie\"  >Epilepsie<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_5' id='label_ff_4_input_text_5'>Andere aandoening namelijk:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" data-name=\"input_text_5\" id=\"ff_4_input_text_5\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_3\" ><p><span style=\"text-decoration: underline\"><strong>Levensstijl<\/strong><\/span><\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_6' id='label_ff_4_input_text_6'>Hoe zijn uw werkomstandigheden? (binnen\/buiten\/overdag\/\u2019s avonds\/\u2019s nachts)<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" data-name=\"input_text_6\" id=\"ff_4_input_text_6\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_multi_select_5' id='label_ff_4_multi_select_5'>Rookt u ?<\/label><\/div><div class='ff-el-input--content'><select name=\"multi_select_5[]\" id=\"ff_4_multi_select_5\" class=\"ff-el-form-control  ff_has_multi_select\" multiple=\"1\" data-name=\"multi_select_5\" data-max_selected_options=\"1\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_4_multi_select_5\"><option value=\"Ja\"  >Ja<\/option><option value=\"Nee\"  >Nee<\/option><\/select><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_7' id='label_ff_4_input_text_7'>Hoeveel alcohol drinkt u per week?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_7\" class=\"ff-el-form-control\" data-name=\"input_text_7\" id=\"ff_4_input_text_7\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_8' id='label_ff_4_input_text_8'>Hoe vaak gaat u naar de zonnebank? <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_8\" class=\"ff-el-form-control\" data-name=\"input_text_8\" id=\"ff_4_input_text_8\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_4\" ><p><span style=\"text-decoration: underline\"><strong>Verwachtingen klant<\/strong><\/span><\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_input_text_9' id='label_ff_4_input_text_9'>Wat verwacht u van uw schoonheidsspecialiste en de behandelingen? Welke huidproblemen zou u willen aanpakken? <\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_9\" class=\"ff-el-form-control\" data-name=\"input_text_9\" id=\"ff_4_input_text_9\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_5\" ><p><strong>Factoren die een negatieve invloed kunnen hebben op het resultaat<\/strong><\/p>\n<ul>\n<li>Menopauze<\/li>\n<li>\u00a0Stress<\/li>\n<li>Hormoonbehandelingen<\/li>\n<li>\u00a0Overmatige blootstelling aan de zon of zonnebank<\/li>\n<li>Recente agressieve huidbehandelingen bv. Fractionele laser<\/li>\n<\/ul>\n<p><strong>Niet aanbevolen voor\/bij:<\/strong><\/p>\n<ul>\n<li>Zwangere vrouwen<\/li>\n<li>Kankerpati\u00ebnten\u00a0<\/li>\n<li>Mensen met hartproblemen<\/li>\n<li>Stollingsstoornissen (hemofilie, gebruik van anticoagulantia)<\/li>\n<li>Extreme gevoelige huid<\/li>\n<li>Herpes in het gelaat\u00a0<\/li>\n<li>Mensen behandeld met Roaccutane 6 maanden voor de behandeling<\/li>\n<\/ul>\n<p><strong>Neveneffecten:<\/strong><\/p>\n<ul>\n<li>Roodheid<\/li>\n<li>Jeuk<\/li>\n<li>Lichte zwelling<\/li>\n<li>Droogheid<\/li>\n<li>Branderig gevoel<\/li>\n<li>Lokale bloedingen<\/li>\n<li>Huidschilfering<\/li>\n<li>Trekkerig gevoel<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Wat te vermijden voor de behandeling:<\/strong><\/p>\n<ul>\n<li>Overmatige blootstelling aan de zon en de zonnebank gedurende 14dagen voor de behandeling<\/li>\n<li>Recente laserebehandeling of andere agressieve behandelingen gedurende 14dagen voor de behandeling\u00a0<\/li>\n<li>Plaatselijke auto-immuunbehandelingen of behandelingen die overgevoeligheid van de huid veroorzaken gedurende 24 uur voor de behandeling<\/li>\n<li>Bloedverdunners (Asaflow, CardioAspirine, clopidogrel, \u2026)<\/li>\n<li>Collageenshotjes die wij bij Skin by Zer aanbieden nemen voor de behandeling<\/li>\n<li>Gebruik van Botox en fillers 21 dagen voor behandeling<\/li>\n<li>14 dagen wachten na een diepe behandeling (peeling\/microneedling)<\/li>\n<li>2 dagen voor de behandeling warmte (sauna, stoombad, \u2026)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Aanbevelingen na de behandeling:<\/strong><\/p>\n<ul>\n<li>Breng 24 uur geen make-up aan<\/li>\n<li>Vermijd overmatige blootstelling aan de zon en de zonnebank gedurende 14dagen<\/li>\n<li>Vermijd warmte (sauna, stoombad, \u2026) 1 week na behandeling<\/li>\n<li>Breng geen agressieve hygi\u00ebneproducten, lotions met alcohol of AHA\u2019s aan gedurende 24-48 uur na de behandeling<\/li>\n<li>Doe geen intensieve lichamelijke inspanningen tot 24 uur na de behandeling<\/li>\n<\/ul><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Ik ben op de hoogte van de aard en de te verwachten resultaten van de voorgenomen behandeling. Ik heb gelezen dat er voor en na de behandelingen bepaalde richtlijnen zijn om een optimaal resultaat te bereiken. Ik heb de behandelaar op de hoogte gesteld van mijn aandoeningen, medicijngebruik en eventuele overgevoeligheden. Ik weet dat er complicaties kunnen optreden en als ik vermoed dat dat het geval is, neem ik contact op. Ik begrijp dat er geen garanties kunnen worden gegeven over het resultaat van de behandeling. Ik heb bovenstaande informatie, de verklaring en het klantenadvies zowel mondeling als schriftelijk ontvangen en begrepen en ga ermee akkoord. Ik onderga de behandeling uit vrije wil en neem daarvoor mijn eigen verantwoordelijkheid.' class='ff-el-form-check-label ff_tc_label' for='terms-n-condition_de19e350b9595f1ef3a305663b287e3c'><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition\" id=\"terms-n-condition_de19e350b9595f1ef3a305663b287e3c\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>Ik ben op de hoogte van de aard en de te verwachten resultaten van de voorgenomen behandeling. Ik heb gelezen dat er voor en na de behandelingen bepaalde richtlijnen zijn om een optimaal resultaat te bereiken. Ik heb de behandelaar op de hoogte gesteld van mijn aandoeningen, medicijngebruik en eventuele overgevoeligheden. Ik weet dat er complicaties kunnen optreden en als ik vermoed dat dat het geval is, neem ik contact op. Ik begrijp dat er geen garanties kunnen worden gegeven over het resultaat van de behandeling. Ik heb bovenstaande informatie, de verklaring en het klantenadvies zowel mondeling als schriftelijk ontvangen en begrepen en ga ermee akkoord. Ik onderga de behandeling uit vrije wil en neem daarvoor mijn eigen verantwoordelijkheid.<\/p><\/div><\/label><\/div><\/div><div class='ff-form-inline-style' hidden><style>form.fluent_form_4 .ff-btn-submit:not(.ff_btn_no_style) { background-color: #409EFF; color: #ffffff; }<\/style><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\"  aria-label=\"Indienen\">Indienen<\/button><\/div><\/fieldset><\/form><div id='fluentform_4_errors' class='ff-errors-in-stack ff_form_instance_4_1 ff-form-loading_errors ff_form_instance_4_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_4_1 = {\"id\":\"4\",\"ajaxUrl\":\"https:\\\/\\\/skinbyzer.be\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\",\"asteriskPlacement\":\"asterisk-right\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_4_1\",\"form_id_selector\":\"fluentform_4\",\"rules\":{\"multi_select_6\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}},\"input_text_12\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"names[first_name]\":{\"required\":{\"value\":true,\"message\":\"Dit veld is verplicht\"}},\"names[middle_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"names[last_name]\":{\"required\":{\"value\":true,\"message\":\"Dit veld is verplicht\"}},\"address_1[address_line_1]\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}},\"address_1[address_line_2]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_1[city]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_1[state]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_1[zip]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_1[country]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_2[address_line_1]\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}},\"address_2[address_line_2]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_2[city]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_2[state]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_2[zip]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_2[country]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_3[address_line_1]\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}},\"address_3[address_line_2]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_3[city]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_3[state]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_3[zip]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"address_3[country]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"names_1[first_name]\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}},\"names_1[middle_name]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"names_1[last_name]\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"email\":{\"required\":{\"value\":true,\"message\":\"Email field is required\"},\"email\":{\"value\":true,\"message\":\"This field must contain a valid email\"}},\"input_text_11\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}},\"description\":{\"required\":{\"value\":false,\"message\":\"This field is required\"}},\"multi_select_1\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}},\"input_text_1\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"input_text_2\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"input_text_3\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}},\"multi_select_2\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"input_text_4\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"multi_select_3\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"multi_select_4\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"input_text_5\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"input_text_6\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"multi_select_5\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"input_text_7\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"input_text_8\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"input_text_9\":{\"required\":{\"value\":false,\"message\":\"Dit veld is vereist\"}},\"terms-n-condition\":{\"required\":{\"value\":true,\"message\":\"Dit veld is vereist\"}}},\"debounce_time\":300,\"file_upload_settings\":[]};\n                            <\/script>\n            <\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-14814","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/skinbyzer.be\/fr\/wp-json\/wp\/v2\/pages\/14814","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/skinbyzer.be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/skinbyzer.be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/skinbyzer.be\/fr\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/skinbyzer.be\/fr\/wp-json\/wp\/v2\/comments?post=14814"}],"version-history":[{"count":5,"href":"https:\/\/skinbyzer.be\/fr\/wp-json\/wp\/v2\/pages\/14814\/revisions"}],"predecessor-version":[{"id":14821,"href":"https:\/\/skinbyzer.be\/fr\/wp-json\/wp\/v2\/pages\/14814\/revisions\/14821"}],"wp:attachment":[{"href":"https:\/\/skinbyzer.be\/fr\/wp-json\/wp\/v2\/media?parent=14814"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}