{"id":2412,"date":"2022-04-13T18:04:17","date_gmt":"2022-04-13T18:04:17","guid":{"rendered":"https:\/\/lassustandartsen.nl\/tilburg\/?page_id=2412"},"modified":"2023-03-15T10:00:27","modified_gmt":"2023-03-15T10:00:27","slug":"klachtenformulier","status":"publish","type":"page","link":"https:\/\/lassustandartsen.nl\/tilburg\/klachtenformulier\/","title":{"rendered":"Klachtenformulier"},"content":{"rendered":"<!-- HTML Forms v1.6.3 - https:\/\/wordpress.org\/plugins\/html-forms\/ -->\n<form method=\"post\"  class=\"hf-form hf-form-2411 \" data-id=\"2411\" data-title=\"Klachtenformulier\" data-slug=\"klachtenformulier\" data-message-success=\"Dank u! We nemen binnen 48 uur tijdens werkdagen contact met u op.\" data-message-invalid-email=\"Excuses, dat e-mailadres lijkt ongeldig.\" data-message-required-field-missing=\"Gelieve de vereiste velden in te vullen.\" data-message-error=\"Oeps. Er is een fout opgetreden.\" data-message-recaptcha-failed=\"reCAPTCHA verification failed. Please try again.\" data-message-recaptcha-low-score=\"Your submission appears to be spam. Please try again.\" data-message-file-too-large=\"Uploaded file is too large.\" data-message-file-upload-error=\"An upload error occurred. Please try again later.\" data-message-submission-limit-reached=\"The submission limit for this form has been reached.\" data-message-require-user-logged-in=\"You must be logged in before you can use this form.\"><input type=\"hidden\" name=\"_hf_form_id\" value=\"2411\" \/><div style=\"display: none;\"><input type=\"text\" name=\"_hf_h2411\" value=\"\" \/><\/div><div class=\"hf-fields-wrap\"><div class=\"grid lg:grid-cols-2 gap-[30px] referral-form\">\r\n\r\n\t<div>\r\n\t\t<label for=\"first-name\" class=\"block mb-2\">Voornaam*<\/label>\r\n\t\t<input type=\"text\" name=\"first-name\" id=\"first-name\" placeholder=\"Vul uw voornaam in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"last-name\" class=\"block mb-2\">Achternaam*<\/label>\r\n\t\t<input type=\"text\" name=\"last-name\" id=\"last-name\" placeholder=\"Vul uw achternaam in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\r\n\t<div>\r\n\t\t<label for=\"birth-date\" class=\"block mb-2\">Geboortedatum*<\/label>\r\n\t\t<input type=\"date\" name=\"birth-date\" id=\"birth-date\" placeholder=\"Voer uw geboortedatum in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"typeof\" class=\"block mb-2\">Wat is de aard van uw klacht?*<\/label>\r\n\t\t<select name=\"typeof\" id=\"typeof\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t\t\t<option value=\"\">Selecteer<\/option>\t\r\n\t\t\t<option value=\"Tandheelkundig\">Tandheelkundig<\/option>\r\n\t\t\t<option value=\"Administratief\">Administratief<\/option>\r\n\t\t\t<option value=\"Informatieverstrekking\">Informatieverstrekking<\/option>\r\n          \t<option value=\"Bejegening\">Bejegening<\/option>\r\n\t\t<\/select>\r\n\t<\/div>\r\n\r\n\t<div>\r\n\t\t<label for=\"phone\" class=\"block mb-2\">Tel. mobiel*<\/label>\r\n\t\t<input type=\"tel\" name=\"phone\" id=\"phone\" placeholder=\"Vul uw telefoonnummer in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\t<div>\r\n\t\t<label for=\"email\" class=\"block mb-2\">E-mailadres*<\/label>\r\n\t\t<input type=\"email\" name=\"email\" id=\"email\" placeholder=\"Vul uw e-mailadres in\" required=\"true\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\r\n\t<div class=\"lg:col-span-2\">\r\n\t\t<label for=\"timetoreach\" class=\"block mb-2\"> Wanneer bent u het best bereikbaar? *<\/label>\r\n\t\t<input type=\"text\" name=\"timetoreach\" id=\"timetoreach\" required=\"true\" placeholder=\"\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\">\r\n\t<\/div>\r\n\r\n\t\r\n\t<div class=\"lg:col-span-2\">\r\n\t\t<label for=\"why\" class=\"block mb-2\"> Hoe komt het dat u ontevreden bent? * <\/label>\r\n\t\t<textarea name=\"why\" id=\"why\" required=\"true\" placeholder=\"\" class=\"w-full placeholder-gray-medium px-5 py-4 border-formborder focus:border-primary focus:ring-primary\"><\/textarea>\r\n\t<\/div>\r\n\r\n\t<div class=\"lg:col-span-2\">\r\n\t\t<label for=\"sppken\" class=\"block mb-2\"> Heeft u hierover al met iemand van Lassus Tandartsen gesproken? 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