{"id":2991,"date":"2021-02-04T12:42:49","date_gmt":"2021-02-04T12:42:49","guid":{"rendered":"https:\/\/support.orthopedics.moveup.care\/formulieren\/de-teleovereenkomst-ondertekenen\/"},"modified":"2021-07-15T08:53:44","modified_gmt":"2021-07-15T08:53:44","slug":"de-teleovereenkomst-ondertekenen","status":"publish","type":"page","link":"https:\/\/support.orthopedics.moveup.care\/nl\/formulieren\/de-teleovereenkomst-ondertekenen\/","title":{"rendered":"De tele-overeenkomst ondertekenen"},"content":{"rendered":"<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_17' style='display:none'><div id='gf_17' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_17' id='gform_17'  action='\/nl\/wp-json\/wp\/v2\/pages\/2991#gf_17' ><div class='gf_invisible 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id='input_17_1_3_container' class='name_first' >\n                                                    <input type='text' name='input_1.3' id='input_17_1_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_17_1_3' >Voornaam<\/label>\n                                                <\/span>\n                            \n                            <span id='input_17_1_6_container' class='name_last' >\n                                                    <input type='text' name='input_1.6' id='input_17_1_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_17_1_6' >Achternaam<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_17_2\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_2\"><label class='gfield_label' for='input_17_2' >E-mail<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_2' id='input_17_2' type='text' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_17_6\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_6\"><label class='gfield_label' for='input_17_6' >Uw RIZIV-nummer<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_17_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_17_26\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_26\"><label class='gfield_label' for='input_17_26' >Uw nationale identiteitsnummer (nodig om in te loggen bij Itsme)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_17_26' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_17_23\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_23\"><label class='gfield_label' for='input_17_23' >Naam van uw praktijk of organisatie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_17_23' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_17_20\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_20\"><label class='gfield_label gfield_label_before_complex'  >Adres van uw praktijk of organisatie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address' id='input_17_20' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_17_20_1_container' >\n                                        <input type='text' name='input_20.1' id='input_17_20_1' value=''    aria-required='true'    \/>\n                                        <label for='input_17_20_1' id='input_17_20_1_label' >Straat + huisnummer<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_17_20_2_container' >\n                                        <input type='text' name='input_20.2' id='input_17_20_2' value=''     aria-required='false'   \/>\n                                        <label for='input_17_20_2' id='input_17_20_2_label' >Adresregel 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_17_20_3_container' >\n                                    <input type='text' name='input_20.3' id='input_17_20_3' value=''    aria-required='true'    \/>\n                                    <label for='input_17_20_3' id='input_17_20_3_label' >Stad<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_17_20_4_container' >\n                                        <input type='text' name='input_20.4' id='input_17_20_4' value=''      aria-required='true'    \/>\n                                        <label for='input_17_20_4' id='input_17_20_4_label' >Staat \/ provincie \/ regio<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_17_20_5_container' >\n                                    <input type='text' name='input_20.5' id='input_17_20_5' value=''    aria-required='true'    \/>\n                                    <label for='input_17_20_5' id='input_17_20_5_label' >Postcode<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country' id='input_17_20_6_container' >\n                                        <select name='input_20.6' id='input_17_20_6'   aria-required='true'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Aland-eilanden' >Aland-eilanden<\/option><option value='Albani\u00eb' >Albani\u00eb<\/option><option value='Algerije' >Algerije<\/option><option value='Amerikaans Samoa' >Amerikaans Samoa<\/option><option value='Amerikaanse Maagdeneilanden' >Amerikaanse Maagdeneilanden<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua en Barbuda' >Antigua en Barbuda<\/option><option value='Arabische Republiek Syri\u00eb' >Arabische Republiek Syri\u00eb<\/option><option value='Argentini\u00eb' >Argentini\u00eb<\/option><option value='Armeni\u00eb' >Armeni\u00eb<\/option><option value='Aruba' >Aruba<\/option><option value='Australi\u00eb' >Australi\u00eb<\/option><option value='Azerbeidzjan' >Azerbeidzjan<\/option><option value='Bahama&#039;s' >Bahama&#039;s<\/option><option value='Bahrein' >Bahrein<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belgi\u00eb' >Belgi\u00eb<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius en Saba' >Bonaire, Sint Eustatius en Saba<\/option><option value='Bosni\u00eb en Herzegovina' >Bosni\u00eb en Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet eiland' >Bouvet eiland<\/option><option value='Brazili\u00eb' >Brazili\u00eb<\/option><option value='Brits-Indisch oceaan gebied' >Brits-Indisch oceaan gebied<\/option><option value='Britse Maagdeneilanden' >Britse Maagdeneilanden<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgarije' >Bulgarije<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodja' >Cambodja<\/option><option value='Canada' >Canada<\/option><option value='Centraal-Afrikaanse Republiek' >Centraal-Afrikaanse Republiek<\/option><option value='Chili' >Chili<\/option><option value='China' >China<\/option><option value='Cocoseilanden' >Cocoseilanden<\/option><option value='Colombia' >Colombia<\/option><option value='Comoren' >Comoren<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratische Republiek' >Congo, Democratische Republiek<\/option><option value='Cook eilanden' >Cook eilanden<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Denemarken' >Denemarken<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominicaanse Republiek' >Dominicaanse Republiek<\/option><option value='Duitsland' >Duitsland<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypte' >Egypte<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatoriaal-Guinea' >Equatoriaal-Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estland' >Estland<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopi\u00eb' >Ethiopi\u00eb<\/option><option value='Faer\u00f6er' >Faer\u00f6er<\/option><option value='Falkland eilanden' >Falkland eilanden<\/option><option value='Fiji' >Fiji<\/option><option value='Filipijnen' >Filipijnen<\/option><option value='Finland' >Finland<\/option><option value='Frankrijk' >Frankrijk<\/option><option value='Frans Guyana' >Frans Guyana<\/option><option value='Frans-Polynesi\u00eb' >Frans-Polynesi\u00eb<\/option><option value='Franse zuidelijke gebieden' >Franse zuidelijke gebieden<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgi\u00eb' >Georgi\u00eb<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Grenada' >Grenada<\/option><option value='Griekenland' >Griekenland<\/option><option value='Groenland' >Groenland<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinee' >Guinee<\/option><option value='Guinee-Bissau' >Guinee-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Ha\u00efti' >Ha\u00efti<\/option><option value='Heard Eiland en McDonald Eilanden' >Heard Eiland en McDonald Eilanden<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hongarije' >Hongarije<\/option><option value='IJsland' >IJsland<\/option><option value='Ierland' >Ierland<\/option><option value='India' >India<\/option><option value='Indonesi\u00eb' >Indonesi\u00eb<\/option><option value='Irak' >Irak<\/option><option value='Iran' >Iran<\/option><option value='Isra\u00ebl' >Isra\u00ebl<\/option><option value='Itali\u00eb' >Itali\u00eb<\/option><option value='Ivoorkust' >Ivoorkust<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordani\u00eb' >Jordani\u00eb<\/option><option value='Kaaimaneilanden' >Kaaimaneilanden<\/option><option value='Kaapverdi\u00eb' >Kaapverdi\u00eb<\/option><option value='Kameroen' >Kameroen<\/option><option value='Kazachstan' >Kazachstan<\/option><option value='Kenia' >Kenia<\/option><option value='Kersteiland' >Kersteiland<\/option><option value='Kirgizi\u00eb' >Kirgizi\u00eb<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kleine eilanden van de Verenigde Staten' >Kleine eilanden van de Verenigde Staten<\/option><option value='Koeweit' >Koeweit<\/option><option value='Korea, Democratische Volksrepubliek' >Korea, Democratische Volksrepubliek<\/option><option value='Korea, Republiek van' >Korea, Republiek van<\/option><option value='Kroati\u00eb' >Kroati\u00eb<\/option><option value='Lao Democratische Volksrepubliek' >Lao Democratische Volksrepubliek<\/option><option value='Lesotho' >Lesotho<\/option><option value='Letland' >Letland<\/option><option value='Libanon' >Libanon<\/option><option value='Liberia' >Liberia<\/option><option value='Libi\u00eb' >Libi\u00eb<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Litouwen' >Litouwen<\/option><option value='Luxemburg' >Luxemburg<\/option><option value='Macau' >Macau<\/option><option value='Madagaskar' >Madagaskar<\/option><option value='Malawi' >Malawi<\/option><option value='Maldiven' >Maldiven<\/option><option value='Maleisi\u00eb' >Maleisi\u00eb<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Man' >Man<\/option><option value='Marokko' >Marokko<\/option><option value='Marshalleilanden' >Marshalleilanden<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritani\u00eb' >Mauritani\u00eb<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldavi\u00eb' >Moldavi\u00eb<\/option><option value='Monaco' >Monaco<\/option><option value='Mongoli\u00eb' >Mongoli\u00eb<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibi\u00eb' >Namibi\u00eb<\/option><option value='Nauru' >Nauru<\/option><option value='Nederland' >Nederland<\/option><option value='Nepal' >Nepal<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nieuw-Caledoni\u00eb' >Nieuw-Caledoni\u00eb<\/option><option value='Nieuw-Zeeland' >Nieuw-Zeeland<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noord-Macedoni\u00eb' >Noord-Macedoni\u00eb<\/option><option value='Noordelijke Marianen' >Noordelijke Marianen<\/option><option value='Noorwegen' >Noorwegen<\/option><option value='Norfolk eiland' >Norfolk eiland<\/option><option value='Oeganda' >Oeganda<\/option><option value='Oekra\u00efne' >Oekra\u00efne<\/option><option value='Oezbekistan' >Oezbekistan<\/option><option value='Oman' >Oman<\/option><option value='Oostenrijk' >Oostenrijk<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestina, Staat' >Palestina, Staat<\/option><option value='Panama' >Panama<\/option><option value='Papoea-Nieuw-Guinea' >Papoea-Nieuw-Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polen' >Polen<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Roemeni\u00eb' >Roemeni\u00eb<\/option><option value='Russische Federatie' >Russische Federatie<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Kitts en Nevis' >Saint Kitts en Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Pierre en Miquelon' >Saint Pierre en Miquelon<\/option><option value='Saint Vincent en de Grenadines' >Saint Vincent en de Grenadines<\/option><option value='Salomonseilanden' >Salomonseilanden<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tom\u00e9 en Principe' >Sao Tom\u00e9 en Principe<\/option><option value='Saoedi-Arabi\u00eb' >Saoedi-Arabi\u00eb<\/option><option value='Senegal' >Senegal<\/option><option value='Servi\u00eb' >Servi\u00eb<\/option><option value='Seychellen' >Seychellen<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Sint-Helena, Hemelvaart en Tristan da Cunha' >Sint-Helena, Hemelvaart en Tristan da Cunha<\/option><option value='Sloveni\u00eb' >Sloveni\u00eb<\/option><option value='Slowakije' >Slowakije<\/option><option value='Soedan' >Soedan<\/option><option value='Somali\u00eb' >Somali\u00eb<\/option><option value='Spanje' >Spanje<\/option><option value='Spitsbergen en Jan Mayen' >Spitsbergen en Jan Mayen<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Suriname' >Suriname<\/option><option value='Tadzjikistan' >Tadzjikistan<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tanzania, de Verenigde Republiek van' >Tanzania, de Verenigde Republiek van<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad en Tobago' >Trinidad en Tobago<\/option><option value='Tsjaad' >Tsjaad<\/option><option value='Tsjechi\u00eb' >Tsjechi\u00eb<\/option><option value='Tunesi\u00eb' >Tunesi\u00eb<\/option><option value='Turkije' >Turkije<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks- en Caicoseilanden' >Turks- en Caicoseilanden<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uruguay' >Uruguay<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Vaticaanstad' >Vaticaanstad<\/option><option value='Venezuela' >Venezuela<\/option><option value='Verenigd Koninkrijk' >Verenigd Koninkrijk<\/option><option value='Verenigde Arabische Emiraten' >Verenigde Arabische Emiraten<\/option><option value='Verenigde Staten' >Verenigde Staten<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis en Futuna' >Wallis en Futuna<\/option><option value='Westelijke Sahara' >Westelijke Sahara<\/option><option value='Wit-Rusland' >Wit-Rusland<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='Zuid Soedan' >Zuid Soedan<\/option><option value='Zuid-Afrika' >Zuid-Afrika<\/option><option value='Zuid-Georgi\u00eb en de Zuidelijke Sandwich eilanden' >Zuid-Georgi\u00eb en de Zuidelijke Sandwich eilanden<\/option><option value='Zweden' >Zweden<\/option><option value='Zwitserland' >Zwitserland<\/option><\/select>\n                                        <label for='input_17_20_6' id='input_17_20_6_label' >Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_17_27\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_27\"><label class='gfield_label' for='input_17_27' >Uw IBAN-nummer voor betalingen<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_27' id='input_17_27' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_17_28\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_28\"><label class='gfield_label' for='input_17_28' >Ondernemingsnummer (KBO)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_17_28' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_17_24\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_24\"><label class='gfield_label'  >Wij willen uw praktijk- of organisatiegegevens en adres tonen op onze website en op een google map. Geef je toestemming?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_24'>\n\t\t\t<li class='gchoice gchoice_17_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='Ja'  id='choice_17_24_0'    \/>\n\t\t\t\t<label for='choice_17_24_0' id='label_17_24_0'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='Nee'  id='choice_17_24_1'    \/>\n\t\t\t\t<label for='choice_17_24_1' id='label_17_24_1'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_4\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_4\">Om de pseudocodes te mogen attesteren in de tele-overeenkomst dient u digitaal \"akkoord\" te gaan met de <a href=\"https:\/\/www.riziv.fgov.be\/SiteCollectionDocuments\/overeenkomst_mob_medische_toepassing_revalidatie_heup_knie.pdf\" target=\"_blank\">conventie tele-overeenkomst<\/a> . Wekelijks wordt een lijst met het RIZIV gedeeld met de kinesitherapeuten die de tele overeenkomst getekend hebben en de <a href=\"https:\/\/moveup.talentlms.com\/\" target=\"_blank\">e-learning cursus van moveUP volgden<\/a>.\n<\/li><li id=\"field_17_5\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_5\"><label class='gfield_label'  >Heb je de e-learning cursus al afgerond?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_5'>\n\t\t\t<li class='gchoice gchoice_17_5_0'>\n\t\t\t\t<input name='input_5' type='radio' value='Ja'  id='choice_17_5_0'    \/>\n\t\t\t\t<label for='choice_17_5_0' id='label_17_5_0'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_5_1'>\n\t\t\t\t<input name='input_5' type='radio' value='Nee'  id='choice_17_5_1'    \/>\n\t\t\t\t<label for='choice_17_5_1' id='label_17_5_1'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_8\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_8\"><label class='gfield_label' for='input_17_8' >Op een schaal van 1 tot 10: Wat vond je van de cursus?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_8' id='input_17_8' type='text'    value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_17_9\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_9\"><label class='gfield_label' for='input_17_9' >Kunt u ons enkele suggesties geven voor verbetering van de e-learning?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_9' id='input_17_9' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_17_3\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_3\"><label class='gfield_label'  >&#039;Onderteken&#039; de hierboven genoemde tele-overeenkomst digitaal door het vakje aan te kruisen:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_3'>\n\t\t\t<li class='gchoice gchoice_17_3_0'>\n\t\t\t\t<input name='input_3' type='radio' value='Ik heb de tele-overeenkomst gelezen en verklaar mij akkoord'  id='choice_17_3_0'    \/>\n\t\t\t\t<label for='choice_17_3_0' id='label_17_3_0'>Ik heb de tele-overeenkomst gelezen en verklaar mij akkoord<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_10\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_10\">U kunt de conventie alleen ondertekenen als u de e-learning hebt voltooid. Kom alsjeblieft terug als je klaar bent met de e-learning.<\/li><li id=\"field_17_13\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_13\"><h2 class=\"gsection_title\">Administratie in verband met de tele-rehabilitatie conventie<\/h2><\/li><li id=\"field_17_14\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_14\">Sommige <a href=\"https:\/\/support.orthopedics.moveup.care\/nl\/knowledge-base\/administratieve-verplichtingen-voor-fysiotherapeuten\/\" target=\"_blank\">financi\u00eble en andere administratieve geplogenheden<\/a> zijn gekoppeld aan het conventie verdrag. <\/li><li id=\"field_17_19\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_19\"><label class='gfield_label'  >Wilt u ook fysieke sessies doen voor de pati\u00ebnten die digitaal worden opgevolgd door b.Clinic en in uw buurt wonen?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_19'>\n\t\t\t<li class='gchoice gchoice_17_19_0'>\n\t\t\t\t<input name='input_19' type='radio' value='Ja'  id='choice_17_19_0'    \/>\n\t\t\t\t<label for='choice_17_19_0' id='label_17_19_0'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_17_19_1'>\n\t\t\t\t<input name='input_19' type='radio' value='Nee'  id='choice_17_19_1'    \/>\n\t\t\t\t<label for='choice_17_19_1' id='label_17_19_1'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_15\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_15\">F2 forfait kan alleen worden geattesteerd in combinatie met F1 en F3 forfaits. Het F2 forfait is bedoeld voor moveUP. moveUP stuurt u aan het einde van de maand een factuur voor dit F2 forfait. <a href=\"https:\/\/support.orthopedics.moveup.care\/knowledge-base\/convention-study-pseudocodes\/\" target=\"_blank\">Klik hier voor een overzicht van de pseudocodes<\/a><\/li><li id=\"field_17_16\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_16\"><label class='gfield_label'  >Ik verklaar dat ik F2-codes voor moveUP ook zal attesteren wanneer ik het getuigschrift voor F1- en F3\/4-codes opmaak. Ik factureer de pati\u00ebnt, moveUP stuurt mij een factuur voor de F2 bedragen die ik heb ontvangen.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_17_16'>\n\t\t\t<li class='gchoice gchoice_17_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='Ik heb dit gelezen en begrepen.'  id='choice_17_16_0'    \/>\n\t\t\t\t<label for='choice_17_16_0' id='label_17_16_0'>Ik heb dit gelezen en begrepen.<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_17_11\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_17_11\"><label class='gfield_label' for='input_17_11' >Eventuele opmerking<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_11' id='input_17_11' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_17' class='gform_button button' value='Opslaan'  onclick='if(window[\"gf_submitting_17\"]){return false;}  window[\"gf_submitting_17\"]=true;  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_17\"]){return false;} window[\"gf_submitting_17\"]=true;  jQuery(\"#gform_17\").trigger(\"submit\",[true]); }' \/> <input type='hidden' name='gform_ajax' value='form_id=17&amp;title=&amp;description=&amp;tabindex=0' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_17' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='17' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_17' value='WyJbXSIsIjFjMGI3OTk0MzgxOTk5MzgwZmFiZDY5ODk3YmFiN2UzIl0=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_target_page_number_17' id='gform_target_page_number_17' value='0' \/>\n            <input type='hidden' class='gform_hidden' name='gform_source_page_number_17' id='gform_source_page_number_17' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_17' id='gform_ajax_frame_17' title='Dit iframe bevat de vereiste logica om Ajax aangedreven Gravity Forms te verwerken.'><\/iframe>\n                <script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\n gform.initializeOnLoaded( function() {gformInitSpinner( 17, 'https:\/\/support.orthopedics.moveup.care\/wp-content\/plugins\/gravityforms\/images\/spinner.svg' );jQuery('#gform_ajax_frame_17').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_17');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_17').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! 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