{"id":3448,"date":"2024-03-28T08:57:18","date_gmt":"2024-03-28T08:57:18","guid":{"rendered":"https:\/\/www.clouddokter.nl\/almere\/medi-mere\/?page_id=3448"},"modified":"2024-03-28T09:08:47","modified_gmt":"2024-03-28T09:08:47","slug":"register","status":"publish","type":"page","link":"https:\/\/www.clouddokter.nl\/almere\/medi-mere\/en\/register\/","title":{"rendered":"Register"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;grid&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; z_index=&#8221;&#8221;][vc_column][vc_column_text]<\/p>\n<h1>Sign Up for CloudDoctor Medi-Mere<\/h1>\n<p>[\/vc_column_text][vc_separator type=&#8221;small&#8221; position=&#8221;left&#8221; color=&#8221;#e48204&#8243; thickness=&#8221;6&#8243;][vc_column_text]You are about to sign up for CloudDoctor Medi-Mere. We thank you in advance for your trust.<\/p>\n<p>&nbsp;<\/p>\n<p>For patients, there are a number of rules:<\/p>\n<ol>\n<li>You are a resident of Almere or its surroundings.<\/li>\n<li>You are open to a digital general practitioner, primarily online, unless physical presence is necessary.<\/li>\n<li>You register online via the website at one of the CloudDoctor practices.<\/li>\n<li>You follow the online triage tool for complaints and act based on this outcome.<\/li>\n<li>You choose an e-appointment, an e-consult, an e-repeat prescription, or a questionnaire.<\/li>\n<\/ol>\n<p>[\/vc_column_text][vc_empty_space][\/vc_column][\/vc_row][vc_row css_animation=&#8221;&#8221; row_type=&#8221;row&#8221; use_row_as_full_screen_section=&#8221;no&#8221; type=&#8221;grid&#8221; angled_section=&#8221;no&#8221; text_align=&#8221;left&#8221; background_image_as_pattern=&#8221;without_pattern&#8221; z_index=&#8221;&#8221;][vc_column]<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar 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class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_24_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_24' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_24_1\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Make a choice<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_1'>\n\t\t\t<div class='gchoice gchoice_24_1_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='I live in Almere'  id='choice_24_1_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_1_0' id='label_24_1_0' class='gform-field-label gform-field-label--type-inline'>I live in Almere<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_1_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_1' type='radio' value='I will be moving to Almere'  id='choice_24_1_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_1_1' id='label_24_1_1' class='gform-field-label gform-field-label--type-inline'>I will be moving to Almere<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_24_3\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_3'>Nickname<\/label><div class='ginput_container ginput_container_text'><input name='input_3' id='input_24_3' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_24_5\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name has_middle_name has_last_name no_suffix gf_name_has_3 ginput_container_name gform-grid-row' id='input_24_5'>\n                            \n                            <span id='input_24_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_24_5_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                    <input type='text' name='input_5.3' id='input_24_5_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            <span id='input_24_5_4_container' class='name_middle gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_24_5_4' class='gform-field-label gform-field-label--type-sub '>Insertion<\/label>\n                                                    <input type='text' name='input_5.4' id='input_24_5_4' value=''   aria-required='false'     \/>\n                                                <\/span>\n                            <span id='input_24_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_24_5_6' class='gform-field-label gform-field-label--type-sub '>Surname<\/label>\n                                                            <input type='text' name='input_5.6' id='input_24_5_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_24_6\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_6'>Social Security Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_24_6' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_7\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_7'>Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_24_7' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Make a choice' >Make a choice<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/div><div id=\"field_24_29\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_29'>Salutation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_29' id='input_24_29' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Make a choice' >Make a choice<\/option><option value='Mr.' >Mr.<\/option><option value='Mrs.' >Mrs.<\/option><\/select><\/div><\/div><div id=\"field_24_8\" class=\"gfield gfield--type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_8'>Phone number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_8' id='input_24_8' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_9\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_9'>Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_24_9' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/jjjj' aria-describedby=\"input_24_9_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_24_9_date_format' class='screen-reader-text'>DD slash MM slash JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_24_9' class='gform_hidden' value='https:\/\/www.clouddokter.nl\/almere\/medi-mere\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_24_10\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_10'>Email address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_10' id='input_24_10' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_24_31\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >I am a student<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_24_31'>By a student, we mean someone between the ages of 18 and 25.<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_31'>\n\t\t\t<div class='gchoice gchoice_24_31_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='Yes'  id='choice_24_31_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_24_31\"   \/>\n\t\t\t\t\t<label for='choice_24_31_0' id='label_24_31_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_31_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_31' type='radio' value='No'  id='choice_24_31_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_31_1' id='label_24_31_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_24_12\" class=\"gfield gfield--type-address gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_24_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_24_12_1_container' >\n                                        <label for='input_24_12_1' id='input_24_12_1_label' class='gform-field-label gform-field-label--type-sub '>Street + house number<\/label>\n                                        <input type='text' name='input_12.1' id='input_24_12_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_24_12_3_container' >\n                                    <label for='input_24_12_3' id='input_24_12_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                    <input type='text' name='input_12.3' id='input_24_12_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_12.4' id='input_24_12_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_24_12_5_container' >\n                                    <label for='input_24_12_5' id='input_24_12_5_label' class='gform-field-label gform-field-label--type-sub '>Postal code<\/label>\n                                    <input type='text' name='input_12.5' id='input_24_12_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_12.6' id='input_24_12_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_24_13' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_24_2' class='gform_page' data-js='page-field-id-13' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_24_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_24_14\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  >We are almost ready to register you, but first, we need your permission for a few more questions.<\/div><fieldset id=\"field_24_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Grant permission to the general practitioner. Your consent is necessary to ensure that we can transfer your medical records:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_15'>\n\t\t\t<div class='gchoice gchoice_24_15_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='For requesting medical records from the previous general practitioner'  id='choice_24_15_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_15_0' id='label_24_15_0' class='gform-field-label gform-field-label--type-inline'>For requesting medical records from the previous general practitioner<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_15_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='I do not give my permission for this'  id='choice_24_15_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_15_1' id='label_24_15_1' class='gform-field-label gform-field-label--type-inline'>I do not give my permission for this<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_24_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Grant permission to the general practitioner. Your consent is necessary to ensure that we can register you with the insurer:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_16'>\n\t\t\t<div class='gchoice gchoice_24_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='For registering the new general practitioner with the health insurance company (ION)'  id='choice_24_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_16_0' id='label_24_16_0' class='gform-field-label gform-field-label--type-inline'>For registering the new general practitioner with the health insurance company (ION)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='I do not give my permission for this'  id='choice_24_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_16_1' id='label_24_16_1' class='gform-field-label gform-field-label--type-inline'>I do not give my permission for this<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_24_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Grant permission to the general practitioner. Would you also like to participate in a medication study? You can give your consent here:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_17'>\n\t\t\t<div class='gchoice gchoice_24_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='For participating in a medication study'  id='choice_24_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_17_0' id='label_24_17_0' class='gform-field-label gform-field-label--type-inline'>For participating in a medication study<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='I do not give my permission for this'  id='choice_24_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_17_1' id='label_24_17_1' class='gform-field-label gform-field-label--type-inline'>I do not give my permission for this<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_24_18\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Grant permission to both the general practitioner and pharmacy. By giving consent, you agree that your file can be accessed in a locum\/emergency situation. (see also www.medi-mere.com\/optin):<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_18'>\n\t\t\t<div class='gchoice gchoice_24_18_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='For access to your data by treating doctors in locum situations (Opt-In)'  id='choice_24_18_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_18_0' id='label_24_18_0' class='gform-field-label gform-field-label--type-inline'>For access to your data by treating doctors in locum situations (Opt-In)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_18_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_18' type='radio' value='I do not give my permission for this'  id='choice_24_18_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_18_1' id='label_24_18_1' class='gform-field-label gform-field-label--type-inline'>I do not give my permission for this<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_24_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Grant permission to both the general practitioner and pharmacy. MyGezondheid.net is a portal for patients. Handy to use!<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_24_19'>\n\t\t\t<div class='gchoice gchoice_24_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='For registration at MijnGezondheid.net (see our website for more info)'  id='choice_24_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_19_0' id='label_24_19_0' class='gform-field-label gform-field-label--type-inline'>For registration at MijnGezondheid.net (see our website for more info)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_24_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='I do not give my permission for this'  id='choice_24_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_24_19_1' id='label_24_19_1' class='gform-field-label gform-field-label--type-inline'>I do not give my permission for this<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_24_20\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_20'>What is your current health center?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_20' id='input_24_20' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_24_21\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_24_21'>Date today<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_21' id='input_24_21' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/jjjj' aria-describedby=\"input_24_21_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_24_21_date_format' class='screen-reader-text'>DD slash MM slash JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_24_21' class='gform_hidden' value='https:\/\/www.clouddokter.nl\/almere\/medi-mere\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_24_22\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Permission to switch<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_22.1' id='input_24_22_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_24_22_1' >By sending, I give permission to contact my previous general practitioner to transfer the records to Medi-Mere<\/label><input type='hidden' name='input_22.2' value='By sending, I give permission to contact my previous general practitioner to transfer the records to Medi-Mere' class='gform_hidden' \/><input type='hidden' name='input_22.3' value='8' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_24_28\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Agree to the rules<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_28.1' id='input_24_28_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_24_28\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_24_28_1' >I agree to the rules<\/label><input type='hidden' name='input_28.2' value='I agree to the rules' class='gform_hidden' \/><input type='hidden' name='input_28.3' value='8' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_24_28' tabindex='0'>For patients, there are a number of rules:<br \/>\n<br \/>\nYou are a resident of Almere or its surroundings.<br \/>\nYou are open to a digital general practitioner, primarily online, unless physical presence is necessary.<br \/>\nYou register online via the website at one of the CloudDoctor practices.<br \/>\nYou follow the online triage tool for complaints and act based on this outcome.<br \/>\nYou choose an e-appointment, an e-consult, an e-repeat prescription, or a questionnaire.<\/div><\/fieldset><fieldset id=\"field_24_27\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below 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