{"id":262,"date":"2026-04-30T16:37:22","date_gmt":"2026-04-30T06:37:22","guid":{"rendered":"https:\/\/www.thephclinic.com\/phc-health-status-questionnaire\/"},"modified":"2026-06-26T13:31:20","modified_gmt":"2026-06-26T03:31:20","slug":"schedule-a-consultation","status":"publish","type":"page","link":"https:\/\/www.thephclinic.com\/nl\/schedule-a-consultation\/","title":{"rendered":"Schedule Consultation"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"262\" class=\"elementor elementor-262\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ede7c6c e-flex e-con-boxed e-con e-parent\" data-id=\"ede7c6c\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8c81ad1 elementor-widget__width-initial elementor-widget elementor-widget-image\" data-id=\"8c81ad1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<a href=\"\/nl\/\">\n\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"266\" height=\"200\" src=\"https:\/\/www.thephclinic.com\/wp-content\/uploads\/2026\/04\/PHClinics_Logo_Blk-1.webp\" class=\"attachment-large size-large wp-image-1516\" alt=\"Updated logo of Precision Health Clinics\" srcset=\"https:\/\/www.thephclinic.com\/wp-content\/uploads\/2026\/04\/PHClinics_Logo_Blk-1.webp 266w, https:\/\/www.thephclinic.com\/wp-content\/uploads\/2026\/04\/PHClinics_Logo_Blk-1-16x12.webp 16w\" sizes=\"(max-width: 266px) 100vw, 266px\" \/>\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-phcroot01 e-con-full e-flex e-con e-parent\" data-id=\"phcroot01\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-phccard01 e-flex e-con-boxed e-con e-child\" data-id=\"phccard01\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-4ca5967 e-con-full e-flex e-con e-child\" data-id=\"4ca5967\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-phcshort1 elementor-widget elementor-widget-shortcode\" data-id=\"phcshort1\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class=\"forminator-ui forminator-custom-form forminator-custom-form-261 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-261\" data-uid=\"6a55a9290959c\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-261\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-261 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"261\"\n\t\t\t\t data-color-option=\"theme\" data-design=\"default\" data-grid=\"open\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"6a55a9290959c\" action=\"\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-pagination-progress\" aria-hidden=\"true\"><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-261--page-0\"\n\t\t\t\tclass=\"forminator-pagination forminator-pagination-start\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-261--page-0-label\"\n\t\t\t\tdata-step=\"0\"\n\t\t\t\tdata-label=\"Step 7\"\n\t\t\t\tdata-actual-label=\"\"\n\t\t\t\tdata-name=\"page-break-1\"\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><div class=\"badge_icon\" aria-hidden=\"true\"><\/div><p class=\"survey_header\"><strong>Huidige gezondheidsstatus<br>Vragenlijst<\/strong><\/p><p class=\"description\">Beantwoord een paar korte vragen, zodat wij voorafgaand aan uw consult een beeld krijgen van uw gezondheid.<\/p><div class=\"survey_divider\" aria-hidden=\"true\"><\/div><p class=\"survey_time\">Dat duurt ongeveer 30 seconden tot 1 minuut<\/p><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-261--page-1\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-261--page-1-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"1\"\n\t\t\t\tdata-label=\"\"\n\t\t\t\tdata-actual-label=\"Step 2\"\n\t\t\t\tdata-name=\"page-break-2\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12  step_1\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-1-6a55a9290959c-label\" aria-describedby=\"forminator-radiogroup-radio-1-6a55a9290959c-description\"><span id=\"forminator-radiogroup-radio-1-6a55a9290959c-label\" class=\"forminator-label\">Heeft u door een arts vastgestelde aanhoudende of chronische gezondheidsklachten? <span class=\"forminator-required\">*<\/span><\/span><span id=\"forminator-radiogroup-radio-1-6a55a9290959c-description\" class=\"forminator-description\">Voorbeelden zijn: hoge bloeddruk, diabetes, astma, schildklierproblemen, hartaandoeningen.<\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a55a9290959c\" class=\"forminator-radio\" title=\"Nee\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-1-6a55a9290959c-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a55a9290959c\" class=\"forminator-radio\" title=\"Ja\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\" aria-describedby=\"forminator-field-radio-1-6a55a9290959c-description\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-261--page-2\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-261--page-2-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"2\"\n\t\t\t\tdata-label=\"Step 2\"\n\t\t\t\tdata-actual-label=\"Step 3\"\n\t\t\t\tdata-name=\"page-break-3\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12  step_2\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-2-6a55a9290959c-label\"><span id=\"forminator-radiogroup-radio-2-6a55a9290959c-label\" class=\"forminator-label\">Beperken uw gezondheidsklachten uw dagelijkse activiteiten? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a55a9290959c\" class=\"forminator-radio\" title=\"Nee\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a55a9290959c\" class=\"forminator-radio\" title=\"Ja\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-261--page-3\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-261--page-3-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"3\"\n\t\t\t\tdata-label=\"Step 3\"\n\t\t\t\tdata-actual-label=\"Step 4\"\n\t\t\t\tdata-name=\"page-break-4\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-3\" class=\"forminator-field-radio forminator-col forminator-col-12  step_3\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-3-6a55a9290959c-label\"><span id=\"forminator-radiogroup-radio-3-6a55a9290959c-label\" class=\"forminator-label\">Bent u de afgelopen 12 maanden in het ziekenhuis geweest voor een medisch probleem? <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-3-label-1\" for=\"forminator-field-radio-3-1-6a55a9290959c\" class=\"forminator-radio\" title=\"Nee\"><input type=\"radio\" name=\"radio-3\" value=\"one\" id=\"forminator-field-radio-3-1-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-3-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><label id=\"forminator-field-radio-3-label-2\" for=\"forminator-field-radio-3-2-6a55a9290959c\" class=\"forminator-radio\" title=\"Ja\"><input type=\"radio\" name=\"radio-3\" value=\"two\" id=\"forminator-field-radio-3-2-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-3-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-261--page-4\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-261--page-4-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"4\"\n\t\t\t\tdata-label=\"Step 4\"\n\t\t\t\tdata-actual-label=\"Step 5\"\n\t\t\t\tdata-name=\"page-break-5\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><p class=\"section_header\"><strong>Heeft u in het verleden last gehad van een van de volgende aandoeningen?<\/strong><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-4\" class=\"forminator-field-radio forminator-col forminator-col-12  step_4\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-4-6a55a9290959c-label\"><span id=\"forminator-radiogroup-radio-4-6a55a9290959c-label\" class=\"forminator-label\">Bloedstolsels <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-4-label-1\" for=\"forminator-field-radio-4-1-6a55a9290959c\" class=\"forminator-radio\" title=\"Nee\"><input type=\"radio\" name=\"radio-4\" value=\"no\" id=\"forminator-field-radio-4-1-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-4-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><label id=\"forminator-field-radio-4-label-2\" for=\"forminator-field-radio-4-2-6a55a9290959c\" class=\"forminator-radio\" title=\"Ja\"><input type=\"radio\" name=\"radio-4\" value=\"yes\" id=\"forminator-field-radio-4-2-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-4-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-5\" class=\"forminator-field-radio forminator-col forminator-col-12  step_4\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-5-6a55a9290959c-label\"><span id=\"forminator-radiogroup-radio-5-6a55a9290959c-label\" class=\"forminator-label\">Leveraandoening <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-5-label-1\" for=\"forminator-field-radio-5-1-6a55a9290959c\" class=\"forminator-radio\" title=\"Nee\"><input type=\"radio\" name=\"radio-5\" value=\"no\" id=\"forminator-field-radio-5-1-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-5-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><label id=\"forminator-field-radio-5-label-2\" for=\"forminator-field-radio-5-2-6a55a9290959c\" class=\"forminator-radio\" title=\"Ja\"><input type=\"radio\" name=\"radio-5\" value=\"yes\" id=\"forminator-field-radio-5-2-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-5-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-6\" class=\"forminator-field-radio forminator-col forminator-col-12  step_4\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-6-6a55a9290959c-label\"><span id=\"forminator-radiogroup-radio-6-6a55a9290959c-label\" class=\"forminator-label\">Beroerte <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-6-label-1\" for=\"forminator-field-radio-6-1-6a55a9290959c\" class=\"forminator-radio\" title=\"Nee\"><input type=\"radio\" name=\"radio-6\" value=\"no\" id=\"forminator-field-radio-6-1-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-6-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><label id=\"forminator-field-radio-6-label-2\" for=\"forminator-field-radio-6-2-6a55a9290959c\" class=\"forminator-radio\" title=\"Ja\"><input type=\"radio\" name=\"radio-6\" value=\"yes\" id=\"forminator-field-radio-6-2-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-6-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-7\" class=\"forminator-field-radio forminator-col forminator-col-12  step_4\"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-radio-7-6a55a9290959c-label\"><span id=\"forminator-radiogroup-radio-7-6a55a9290959c-label\" class=\"forminator-label\">Hormoongevoelige kanker <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-7-label-1\" for=\"forminator-field-radio-7-1-6a55a9290959c\" class=\"forminator-radio\" title=\"Nee\"><input type=\"radio\" name=\"radio-7\" value=\"no\" id=\"forminator-field-radio-7-1-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-7-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Nee<\/span><\/label><label id=\"forminator-field-radio-7-label-2\" for=\"forminator-field-radio-7-2-6a55a9290959c\" class=\"forminator-radio\" title=\"Ja\"><input type=\"radio\" name=\"radio-7\" value=\"yes\" id=\"forminator-field-radio-7-2-6a55a9290959c\" aria-labelledby=\"forminator-field-radio-7-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Ja<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-261--page-5\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-261--page-5-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"5\"\n\t\t\t\tdata-label=\"Step 5\"\n\t\t\t\tdata-actual-label=\"Step 6\"\n\t\t\t\tdata-name=\"page-break-6\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-3\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-3\"><p class=\"section_header\"><strong>Contactgegevens<\/strong><\/p><p class=\"section_subtitle\">Geef alstublieft uw contactgegevens door, zodat we contact met u kunnen opnemen over uw consult.<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_6a55a9290959c\" id=\"forminator-field-name-1_6a55a9290959c-label\" class=\"forminator-label\">Voornaam <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"Voer uw voornaam in\" id=\"forminator-field-name-1_6a55a9290959c\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"name-2\" class=\"forminator-field-name forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-name-2_6a55a9290959c\" id=\"forminator-field-name-2_6a55a9290959c-label\" class=\"forminator-label\">Achternaam <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-2\" value=\"\" placeholder=\"Voer uw achternaam in\" id=\"forminator-field-name-2_6a55a9290959c\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_6a55a9290959c\" id=\"forminator-field-phone-1_6a55a9290959c-label\" class=\"forminator-label\">Telefoonnummer <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"+971 50 123 4567\" id=\"forminator-field-phone-1_6a55a9290959c\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-12\"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_6a55a9290959c\" id=\"forminator-field-email-1_6a55a9290959c-label\" class=\"forminator-label\">E-mail <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"name@example.com\" id=\"forminator-field-email-1_6a55a9290959c\" class=\"forminator-input forminator-email--field\" data-required=\"1\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><\/div><\/div><div\n\t\t\t\ttabindex=\"-1\"\n\t\t\t\trole=\"tabpanel\"\n\t\t\t\tid=\"forminator-custom-form-261--page-6\"\n\t\t\t\tclass=\"forminator-pagination\"\n\t\t\t\taria-labelledby=\"forminator-custom-form-261--page-6-label\"\n\t\t\t\taria-hidden=\"true\"\n\t\t\t\tdata-step=\"6\"\n\t\t\t\tdata-label=\"Step 6\"\n\t\t\t\tdata-actual-label=\"Step 7\"\n\t\t\t\tdata-name=\"\"\n\t\t\t\thidden\n\t\t\t><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-4\" class=\"forminator-field-html forminator-col forminator-col-12\"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-4\"><p class=\"section_header\"><strong>Toestemming voor medische behandeling en medische gegevens<\/strong><\/p>\n<div class=\"consent_box\">\n<ul>\n<li>Ik bevestig dat de verstrekte informatie juist is.<\/li>\n<li>Ik geef toestemming voor een gezondheidsbeoordeling op basis van mijn antwoorden.<\/li>\n<li>Ik begrijp dat dit een voorlopige beoordeling is.<\/li>\n<li>Ik ga akkoord met het privacybeleid en de gebruiksvoorwaarden.<\/li>\n<li>Ik geef Precision Health Clinics toestemming om contact met mij op te nemen in verband met mijn consult.<\/li>\n<\/ul>\n<\/div><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12\"><div role=\"group\" class=\"forminator-field required\" aria-labelledby=\"forminator-checkbox-group-forminator-field-checkbox-1-6a55a9290959c-label\"><label id=\"forminator-field-checkbox-1-1-6a55a9290959c-label\" for=\"forminator-field-checkbox-1-1-6a55a9290959c\" class=\"forminator-checkbox\" title=\"Ik ga akkoord met de bovenstaande voorwaarden\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-1-6a55a9290959c\" aria-labelledby=\"forminator-field-checkbox-1-1-6a55a9290959c-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ik ga akkoord met de bovenstaande voorwaarden<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row forminator-hidden\"><div id=\"hidden-1\" class=\"forminator-field-hidden  forminator-col-12  consultation_page_url\"><input type=\"hidden\" id=\"hidden-1_6a55a9290959c\" class=\"consultation_page_url\" name=\"hidden-1\" value=\"https:\/\/www.thephclinic.com\/nl\/schedule-a-consultation\/\" \/><\/div><\/div><\/div><button class=\"forminator-button forminator-pagination-submit\" style=\"display: none;\" disabled>Verzenden<\/button><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"31f1ba2337\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/nl\/wp-json\/wp\/v2\/pages\/262\" \/><input type=\"hidden\" name=\"form_id\" value=\"261\"><input type=\"hidden\" name=\"page_id\" value=\"262\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.thephclinic.com\/nl\/schedule-a-consultation\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><input type=\"hidden\" name=\"trp-form-language\" value=\"nl\"\/><\/form><\/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\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1cb0f99 phc-reveal-cascade phc-footer e-flex e-con-boxed e-con e-parent\" data-id=\"1cb0f99\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-0809244 e-con-full phc-reveal phc-footer__brand e-flex e-con e-child\" data-id=\"0809244\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-11cde14 phc-footer__logo elementor-widget__width-initial elementor-widget elementor-widget-image\" data-id=\"11cde14\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"266\" height=\"200\" src=\"https:\/\/www.thephclinic.com\/wp-content\/uploads\/2026\/04\/PHClinics_Logo_Blk-1.webp\" class=\"attachment-full size-full wp-image-1516\" alt=\"Updated logo of Precision Health Clinics\" srcset=\"https:\/\/www.thephclinic.com\/wp-content\/uploads\/2026\/04\/PHClinics_Logo_Blk-1.webp 266w, https:\/\/www.thephclinic.com\/wp-content\/uploads\/2026\/04\/PHClinics_Logo_Blk-1-16x12.webp 16w\" sizes=\"(max-width: 266px) 100vw, 266px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0a8d3df phc-footer__copy elementor-widget elementor-widget-heading\" data-id=\"0a8d3df\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">\u00a9 2026 by Precision Health Clinics<\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-2dcacc0 e-con-full phc-footer__links e-flex e-con e-child\" data-id=\"2dcacc0\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-1197710 e-con-full phc-reveal phc-footer__col phc-footer__col--2 e-flex e-con e-child\" data-id=\"1197710\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-218c658 phc-footer__col-heading elementor-widget elementor-widget-heading\" data-id=\"218c658\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Ontdek<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cbabd78 phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"cbabd78\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"\/nl\/feedback-complaints\/\">Feedback<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7c18ba9 phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"7c18ba9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"\/nl\/white-papers\/\">White Papers<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1ef92d1 e-con-full phc-reveal phc-footer__col phc-footer__col--2 e-flex e-con e-child\" data-id=\"1ef92d1\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4af7168 phc-footer__col-heading elementor-widget elementor-widget-heading\" data-id=\"4af7168\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h4 class=\"elementor-heading-title elementor-size-default\">Social<\/h4>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-862660b phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"862660b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/www.facebook.com\/profile.php?id=61557549268278\" target=\"_blank\" rel=\"noopener\">Facebook<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2e6f6eb phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"2e6f6eb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/www.instagram.com\/precisionhealth_clinic\/\" target=\"_blank\" rel=\"noopener\">Instagram<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8a035f3 phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"8a035f3\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/www.youtube.com\/@Precisionhealthclinic\" target=\"_blank\" rel=\"noopener\">Youtube<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-49880a2 e-con-full phc-reveal phc-footer__col phc-footer__col--3 phc-footer__col--contact e-flex e-con e-child\" data-id=\"49880a2\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-443ac71 phc-footer__col-heading elementor-widget elementor-widget-heading\" data-id=\"443ac71\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">Contact<\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-e72c595 phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"e72c595\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"mailto:info@thephclinic.com\">info@thephclinic.com<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-69345d9 phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"69345d9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"tel:+31208208370\">Tel. +31 (0)208 20 83 70<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5b0ec5c phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"5b0ec5c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"https:\/\/share.google\/httOEyIqOUUV1D6I3\" target=\"_blank\" rel=\"noopener\">Boeingavenue 203, 1119 PD Schiphol-Rijk<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-7db4bef e-con-full phc-reveal phc-footer__col phc-footer__col--4 phc-footer__col--legal e-flex e-con e-child\" data-id=\"7db4bef\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3d5155d phc-footer__col-heading elementor-widget elementor-widget-heading\" data-id=\"3d5155d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\">Juridisch<\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-02c9ba8 phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"02c9ba8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"\/nl\/terms-conditions\/\">Algemene voorwaarden<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a301123 phc-footer__link elementor-widget elementor-widget-heading\" data-id=\"a301123\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<span class=\"elementor-heading-title elementor-size-default\"><a href=\"\/nl\/privacy-policy\/\">Privacybeleid<\/a><\/span>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>\u00a9 2026 by Precision Health Clinics Explore Feedback White Papers Social Facebook Instagram Youtube Contact info@thephclinic.com Tel. +31 (0)208 20 83 70 Boeingavenue 203, 1119 PD Schiphol-Rijk Legal Terms &amp; Conditions Privacy Policy<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_canvas","meta":{"footnotes":""},"class_list":["post-262","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.thephclinic.com\/nl\/wp-json\/wp\/v2\/pages\/262","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.thephclinic.com\/nl\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.thephclinic.com\/nl\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.thephclinic.com\/nl\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.thephclinic.com\/nl\/wp-json\/wp\/v2\/comments?post=262"}],"version-history":[{"count":6,"href":"https:\/\/www.thephclinic.com\/nl\/wp-json\/wp\/v2\/pages\/262\/revisions"}],"predecessor-version":[{"id":3938,"href":"https:\/\/www.thephclinic.com\/nl\/wp-json\/wp\/v2\/pages\/262\/revisions\/3938"}],"wp:attachment":[{"href":"https:\/\/www.thephclinic.com\/nl\/wp-json\/wp\/v2\/media?parent=262"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}