{"id":10356,"date":"2026-06-17T21:19:31","date_gmt":"2026-06-17T19:19:31","guid":{"rendered":"https:\/\/www.atlaspraxis.de\/?page_id=10356"},"modified":"2026-07-08T19:30:52","modified_gmt":"2026-07-08T17:30:52","slug":"anamnese","status":"publish","type":"page","link":"https:\/\/www.atlaspraxis.de\/en\/anamnese\/","title":{"rendered":"Anamnese"},"content":{"rendered":"\n<figure class=\"wp-block-image size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"1600\" height=\"200\" src=\"https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Anamnese.png\" alt=\"Anamnese\" class=\"wp-image-10570\" style=\"width:600px\" srcset=\"https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Anamnese.png 1600w, https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Anamnese-600x75.png 600w, https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Anamnese-1024x128.png 1024w, https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Anamnese-768x96.png 768w, https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Anamnese-1536x192.png 1536w\" sizes=\"auto, (max-width: 1600px) 100vw, 1600px\" \/><\/figure>\n\n\n<div class=\"wpforms-container wpforms-render-modern\" id=\"wpforms-10358\"><form id=\"wpforms-form-10358\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"10358\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/10356\" data-token=\"777031ec6b42486d64f41750ba9b36c0\" data-token-time=\"1785197474\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-10358-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_1\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-10358-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" aria-errormessage=\"wpforms-10358-field_1-error\" required><\/div><div id=\"wpforms-10358-field_2-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_2\">Datum <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-10358-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" value=\"28.07.2026\" aria-errormessage=\"wpforms-10358-field_2-error\" required><\/div><div id=\"wpforms-10358-field_39-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_39\">Patienten-ID (wenn vorhanden)<\/label><input type=\"text\" id=\"wpforms-10358-field_39\" class=\"wpforms-field-medium\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-10358-field_39-error\" aria-describedby=\"wpforms-10358-field_39-description\" ><div id=\"wpforms-10358-field_39-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_3-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_3\">Was ist der Hauptgrund Ihres Besuchs?<\/label><textarea id=\"wpforms-10358-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-10358-field_3-error\" ><\/textarea><\/div>\t\t<div id=\"wpforms-10358-field_5-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"5\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-10358-field_5\" >Lebensmittel, instabil, Unf\u00e4lle,<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-10358-field_5\" class=\"wpforms-field-medium\" name=\"wpforms[fields][5]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-10358-field_4-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">Seit wann bestehen die Beschwerden?<\/legend><ul id=\"wpforms-10358-field_4\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_4_1\" name=\"wpforms[fields][4][]\" value=\"Seit Tagen\" aria-errormessage=\"wpforms-10358-field_4_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_4_1\">Seit Tagen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_4_2\" name=\"wpforms[fields][4][]\" value=\"Seit Wochen\" aria-errormessage=\"wpforms-10358-field_4_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_4_2\">Seit Wochen<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_4_3\" name=\"wpforms[fields][4][]\" value=\"Seit Monaten\" aria-errormessage=\"wpforms-10358-field_4_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_4_3\">Seit Monaten<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_4_4\" name=\"wpforms[fields][4][]\" value=\"Seit Jahren\" aria-errormessage=\"wpforms-10358-field_4_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_4_4\">Seit Jahren<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_6-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_6\">Wie stark sind die Beschwerden aktuell auf einer Skala von 0 bis 10?<\/label>\n<input\n\ttype=\"range\"\n\tid=\"wpforms-10358-field_6\" class=\"wpforms-field-medium\" name=\"wpforms[fields][6]\" value=\"0\" aria-errormessage=\"wpforms-10358-field_6-error\"\t\tmin=\"0\"\n\tmax=\"10\"\n\tstep=\"1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Gew\u00e4hlter Wert: {value}\">\n\tGew\u00e4hlter Wert: <b>0<\/b><\/div>\n<\/div><div id=\"wpforms-10358-field_7-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_7\">Beschreiben Sie Ihre Beschwerden:<\/label><textarea id=\"wpforms-10358-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-10358-field_7-error\" aria-describedby=\"wpforms-10358-field_7-description\" ><\/textarea><div id=\"wpforms-10358-field_7-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_8-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"8\"><fieldset><legend class=\"wpforms-field-label\">Kopf-, Nacken- und Kieferbereich<\/legend><ul id=\"wpforms-10358-field_8\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_1\" name=\"wpforms[fields][8][]\" value=\"Nackenschmerzen\" aria-errormessage=\"wpforms-10358-field_8_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_1\">Nackenschmerzen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_2\" name=\"wpforms[fields][8][]\" value=\"Bewegungseinschr\u00e4nkung der Halswirbels\u00e4ule\" aria-errormessage=\"wpforms-10358-field_8_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_2\">Bewegungseinschr\u00e4nkung der Halswirbels\u00e4ule<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_3\" name=\"wpforms[fields][8][]\" value=\"Spannungskopfschmerzen\" aria-errormessage=\"wpforms-10358-field_8_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_3\">Spannungskopfschmerzen<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_4\" name=\"wpforms[fields][8][]\" value=\"Migr\u00e4ne\" aria-errormessage=\"wpforms-10358-field_8_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_4\">Migr\u00e4ne<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_5\" name=\"wpforms[fields][8][]\" value=\"Schwindel\" aria-errormessage=\"wpforms-10358-field_8_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_5\">Schwindel<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_6\" name=\"wpforms[fields][8][]\" value=\"Brain-fog\" aria-errormessage=\"wpforms-10358-field_8_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_6\">Brain-fog<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_7\" name=\"wpforms[fields][8][]\" value=\"Ohrger\u00e4uschen (Tinnitus)\" aria-errormessage=\"wpforms-10358-field_8_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_7\">Ohrger\u00e4uschen (Tinnitus)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_8\" name=\"wpforms[fields][8][]\" value=\"Kiefergelenksbeschwerden\" aria-errormessage=\"wpforms-10358-field_8_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_8\">Kiefergelenksbeschwerden<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_9\" name=\"wpforms[fields][8][]\" value=\"Z\u00e4hneknirschen\" aria-errormessage=\"wpforms-10358-field_8_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_9\">Z\u00e4hneknirschen<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_10\" name=\"wpforms[fields][8][]\" value=\"Sehst\u00f6rungen\" aria-errormessage=\"wpforms-10358-field_8_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_10\">Sehst\u00f6rungen<\/label><\/li><li class=\"choice-11 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_8_11\" name=\"wpforms[fields][8][]\" value=\"Konzentrationsproblemen\" aria-errormessage=\"wpforms-10358-field_8_11-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_8_11\">Konzentrationsproblemen<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_13\">Anmerkungen zu Kopf-, Nacken- und Kieferbereich<\/label><textarea id=\"wpforms-10358-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-10358-field_13-error\" aria-describedby=\"wpforms-10358-field_13-description\" ><\/textarea><div id=\"wpforms-10358-field_13-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_9-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">R\u00fccken und Bewegungsapparat<\/legend><ul id=\"wpforms-10358-field_9\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_1\" name=\"wpforms[fields][9][]\" value=\"R\u00fcckenschmerzen\" aria-errormessage=\"wpforms-10358-field_9_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_1\">R\u00fcckenschmerzen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_2\" name=\"wpforms[fields][9][]\" value=\"Bandscheibenproblemen\" aria-errormessage=\"wpforms-10358-field_9_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_2\">Bandscheibenproblemen<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_3\" name=\"wpforms[fields][9][]\" value=\"Ischiasbeschwerden\" aria-errormessage=\"wpforms-10358-field_9_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_3\">Ischiasbeschwerden<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_4\" name=\"wpforms[fields][9][]\" value=\"H\u00fcftbeschwerden\" aria-errormessage=\"wpforms-10358-field_9_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_4\">H\u00fcftbeschwerden<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_5\" name=\"wpforms[fields][9][]\" value=\"Kniebeschwerden\" aria-errormessage=\"wpforms-10358-field_9_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_5\">Kniebeschwerden<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_6\" name=\"wpforms[fields][9][]\" value=\"Fu\u00dfbeschwerden\" aria-errormessage=\"wpforms-10358-field_9_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_6\">Fu\u00dfbeschwerden<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_7\" name=\"wpforms[fields][9][]\" value=\"Schulter-\/Armbeschwerden\" aria-errormessage=\"wpforms-10358-field_9_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_7\">Schulter-\/Armbeschwerden<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_8\" name=\"wpforms[fields][9][]\" value=\"Arthrose\" aria-errormessage=\"wpforms-10358-field_9_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_8\">Arthrose<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_9_9\" name=\"wpforms[fields][9][]\" value=\"Muskelverspannungen\" aria-errormessage=\"wpforms-10358-field_9_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_9_9\">Muskelverspannungen<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_12-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_12\">Anmerkungen R\u00fccken und Bewegungsapparat<\/label><textarea id=\"wpforms-10358-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-10358-field_12-error\" aria-describedby=\"wpforms-10358-field_12-description\" ><\/textarea><div id=\"wpforms-10358-field_12-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_10-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"10\"><fieldset><legend class=\"wpforms-field-label\">Unf\u00e4lle, Verletzungen und Operationen<\/legend><ul id=\"wpforms-10358-field_10\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_10_1\" name=\"wpforms[fields][10][]\" value=\"Schleudertrauma\" aria-errormessage=\"wpforms-10358-field_10_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_10_1\">Schleudertrauma<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_10_2\" name=\"wpforms[fields][10][]\" value=\"Sturz auf Kopf\" aria-errormessage=\"wpforms-10358-field_10_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_10_2\">Sturz auf Kopf<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_10_3\" name=\"wpforms[fields][10][]\" value=\"Verkehrsunfall\" aria-errormessage=\"wpforms-10358-field_10_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_10_3\">Verkehrsunfall<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_10_4\" name=\"wpforms[fields][10][]\" value=\"Fahrradunfall\" aria-errormessage=\"wpforms-10358-field_10_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_10_4\">Fahrradunfall<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_10_5\" name=\"wpforms[fields][10][]\" value=\"Sportunfall\" aria-errormessage=\"wpforms-10358-field_10_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_10_5\">Sportunfall<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_10_6\" name=\"wpforms[fields][10][]\" value=\"Knochenbr\u00fcche\" aria-errormessage=\"wpforms-10358-field_10_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_10_6\">Knochenbr\u00fcche<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_10_7\" name=\"wpforms[fields][10][]\" value=\"Operationen\" aria-errormessage=\"wpforms-10358-field_10_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_10_7\">Operationen<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_10_8\" name=\"wpforms[fields][10][]\" value=\"Sch\u00e4delverletzungen\" aria-errormessage=\"wpforms-10358-field_10_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_10_8\">Sch\u00e4delverletzungen<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_11-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"11\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_11\">Anmerkungen zu Unf\u00e4lle, Verletzungen und Operationen<\/label><textarea id=\"wpforms-10358-field_11\" class=\"wpforms-field-medium\" name=\"wpforms[fields][11]\" aria-errormessage=\"wpforms-10358-field_11-error\" aria-describedby=\"wpforms-10358-field_11-description\" ><\/textarea><div id=\"wpforms-10358-field_11-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_14-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">Geburt und Kindheit<\/legend><ul id=\"wpforms-10358-field_14\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_14_1\" name=\"wpforms[fields][14][]\" value=\"Nat\u00fcrliche Geburt\" aria-errormessage=\"wpforms-10358-field_14_1-error\" aria-describedby=\"wpforms-10358-field_14-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_14_1\">Nat\u00fcrliche Geburt<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_14_2\" name=\"wpforms[fields][14][]\" value=\"Kaiserschnitt\" aria-errormessage=\"wpforms-10358-field_14_2-error\" aria-describedby=\"wpforms-10358-field_14-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_14_2\">Kaiserschnitt<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_14_3\" name=\"wpforms[fields][14][]\" value=\"Saugglocke oder Zangengeburt\" aria-errormessage=\"wpforms-10358-field_14_3-error\" aria-describedby=\"wpforms-10358-field_14-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_14_3\">Saugglocke oder Zangengeburt<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_14_4\" name=\"wpforms[fields][14][]\" value=\"Fr\u00fchgeburt\" aria-errormessage=\"wpforms-10358-field_14_4-error\" aria-describedby=\"wpforms-10358-field_14-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_14_4\">Fr\u00fchgeburt<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_14_5\" name=\"wpforms[fields][14][]\" value=\"Unbekannt\" aria-errormessage=\"wpforms-10358-field_14_5-error\" aria-describedby=\"wpforms-10358-field_14-description\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_14_5\">Unbekannt<\/label><\/li><\/ul><div id=\"wpforms-10358-field_14-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/fieldset><\/div><div id=\"wpforms-10358-field_15-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"15\"><fieldset><legend class=\"wpforms-field-label\">Allgemeine Gesundheit<\/legend><ul id=\"wpforms-10358-field_15\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_1\" name=\"wpforms[fields][15][]\" value=\"Bluthochdruck\" aria-errormessage=\"wpforms-10358-field_15_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_1\">Bluthochdruck<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_2\" name=\"wpforms[fields][15][]\" value=\"Herz-Kreislauf-Erkrankungen\" aria-errormessage=\"wpforms-10358-field_15_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_2\">Herz-Kreislauf-Erkrankungen<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_3\" name=\"wpforms[fields][15][]\" value=\"Diabetes\" aria-errormessage=\"wpforms-10358-field_15_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_3\">Diabetes<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_4\" name=\"wpforms[fields][15][]\" value=\"Rheumatische Erkrankungen\" aria-errormessage=\"wpforms-10358-field_15_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_4\">Rheumatische Erkrankungen<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_5\" name=\"wpforms[fields][15][]\" value=\"Osteoporose\" aria-errormessage=\"wpforms-10358-field_15_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_5\">Osteoporose<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_6\" name=\"wpforms[fields][15][]\" value=\"Neurologische Erkrankungen\" aria-errormessage=\"wpforms-10358-field_15_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_6\">Neurologische Erkrankungen<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_7\" name=\"wpforms[fields][15][]\" value=\"Chronische Schmerzen\" aria-errormessage=\"wpforms-10358-field_15_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_7\">Chronische Schmerzen<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_8\" name=\"wpforms[fields][15][]\" value=\"Psychische Beschwerden\" aria-errormessage=\"wpforms-10358-field_15_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_8\">Psychische Beschwerden<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_15_9\" name=\"wpforms[fields][15][]\" value=\"Ersch\u00f6pfung \/ M\u00fcdigkeit\" aria-errormessage=\"wpforms-10358-field_15_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_15_9\">Ersch\u00f6pfung \/ M\u00fcdigkeit<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_16-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_16\">Anmerkungen zu allgemeine Gesundheit<\/label><textarea id=\"wpforms-10358-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-10358-field_16-error\" aria-describedby=\"wpforms-10358-field_16-description\" ><\/textarea><div id=\"wpforms-10358-field_16-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_17-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">Medikamente<\/legend><ul id=\"wpforms-10358-field_17\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_1\" name=\"wpforms[fields][17][]\" value=\"Schmerzmittel (z.B. Ibuprofen, Diclofenac, Naproxen, Paracetamol, Metamizol (Novalgin\u00ae))\" aria-errormessage=\"wpforms-10358-field_17_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_1\">Schmerzmittel (z.B. Ibuprofen, Diclofenac, Naproxen, Paracetamol, Metamizol (Novalgin\u00ae))<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_2\" name=\"wpforms[fields][17][]\" value=\"Blutverd\u00fcnner (z.B. ASS (Aspirin\u00ae), Clopidogrel, Apixaban (Eliquis\u00ae), Rivaroxaban (Xarelto\u00ae), Marcumar\u00ae \/ Warfarin)\" aria-errormessage=\"wpforms-10358-field_17_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_2\">Blutverd\u00fcnner (z.B. ASS (Aspirin\u00ae), Clopidogrel, Apixaban (Eliquis\u00ae), Rivaroxaban (Xarelto\u00ae), Marcumar\u00ae \/ Warfarin)<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_3\" name=\"wpforms[fields][17][]\" value=\"Blutdruck- und Herzmedikamente (z.B. Blutdrucksenker, Betablocker, Herzrhythmusmedikamente)\" aria-errormessage=\"wpforms-10358-field_17_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_3\">Blutdruck- und Herzmedikamente (z.B. Blutdrucksenker, Betablocker, Herzrhythmusmedikamente)<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_4\" name=\"wpforms[fields][17][]\" value=\"Diabetesmedikamente (z.B. Metformin, Insulin)\" aria-errormessage=\"wpforms-10358-field_17_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_4\">Diabetesmedikamente (z.B. Metformin, Insulin)<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_5\" name=\"wpforms[fields][17][]\" value=\"Schilddr\u00fcsenmedikamente (z.B. L-Thyroxin)\" aria-errormessage=\"wpforms-10358-field_17_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_5\">Schilddr\u00fcsenmedikamente (z.B. L-Thyroxin)<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_6\" name=\"wpforms[fields][17][]\" value=\"Magenmedikamente (z.B. Pantoprazol, Omeprazol)\" aria-errormessage=\"wpforms-10358-field_17_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_6\">Magenmedikamente (z.B. Pantoprazol, Omeprazol)<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_7\" name=\"wpforms[fields][17][]\" value=\"Psychopharmaka (z.B. Antidepressiva, Beruhigungsmittel, Schlafmittel)\" aria-errormessage=\"wpforms-10358-field_17_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_7\">Psychopharmaka (z.B. Antidepressiva, Beruhigungsmittel, Schlafmittel)<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_8\" name=\"wpforms[fields][17][]\" value=\"Kortison (z.B. Kortisontabletten, Kortisonspray)\" aria-errormessage=\"wpforms-10358-field_17_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_8\">Kortison (z.B. Kortisontabletten, Kortisonspray)<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_9\" name=\"wpforms[fields][17][]\" value=\"Medikamente gegen Osteoporose (z.B. Alendrons\u00e4ure (Fosamax\u00ae), Risedrons\u00e4ure (Actonel\u00ae), Ibandrons\u00e4ure (Bonviva\u00ae), Zoledrons\u00e4ure (Aclasta\u00ae), Denosumab (Prolia\u00ae), Teriparatid (Forsteo\u00ae), Romosozumab (Evenity\u00ae), Raloxifen (Evista\u00ae))\" aria-errormessage=\"wpforms-10358-field_17_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_9\">Medikamente gegen Osteoporose (z.B. Alendrons\u00e4ure (Fosamax\u00ae), Risedrons\u00e4ure (Actonel\u00ae), Ibandrons\u00e4ure (Bonviva\u00ae), Zoledrons\u00e4ure (Aclasta\u00ae), Denosumab (Prolia\u00ae), Teriparatid (Forsteo\u00ae), Romosozumab (Evenity\u00ae), Raloxifen (Evista\u00ae))<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_17_10\" name=\"wpforms[fields][17][]\" value=\"Medikamente gegen Rheuma und Autoimmunerkrankungen (z.B: Methotrexat (MTX), Leflunomid (Arava\u00ae), Sulfasalazin, Hydroxychloroquin (Quensyl\u00ae), Azathioprin, Mycophenolat-Mofetil, Ciclosporin, Biologika, JAK-Inhibitoren, Kortisonpr\u00e4parate)\" aria-errormessage=\"wpforms-10358-field_17_10-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_17_10\">Medikamente gegen Rheuma und Autoimmunerkrankungen (z.B: Methotrexat (MTX), Leflunomid (Arava\u00ae), Sulfasalazin, Hydroxychloroquin (Quensyl\u00ae), Azathioprin, Mycophenolat-Mofetil, Ciclosporin, Biologika, JAK-Inhibitoren, Kortisonpr\u00e4parate)<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_18\">Sonstige Medikamente<\/label><textarea id=\"wpforms-10358-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-10358-field_18-error\" aria-describedby=\"wpforms-10358-field_18-description\" ><\/textarea><div id=\"wpforms-10358-field_18-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/>\n<\/div><\/div><div id=\"wpforms-10358-field_19-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Nahrungserg\u00e4nzungsmittel<\/legend><ul id=\"wpforms-10358-field_19\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_19_1\" name=\"wpforms[fields][19][]\" value=\"Magnesium\" aria-errormessage=\"wpforms-10358-field_19_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_19_1\">Magnesium<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_19_2\" name=\"wpforms[fields][19][]\" value=\"Vitamin D\" aria-errormessage=\"wpforms-10358-field_19_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_19_2\">Vitamin D<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_19_3\" name=\"wpforms[fields][19][]\" value=\"Multivitamine\" aria-errormessage=\"wpforms-10358-field_19_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_19_3\">Multivitamine<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_19_4\" name=\"wpforms[fields][19][]\" value=\"Omega-3-Fetts\u00e4uren\" aria-errormessage=\"wpforms-10358-field_19_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_19_4\">Omega-3-Fetts\u00e4uren<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_24-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_24\">Sonstige Nahrungserg\u00e4nzungsmittel<\/label><textarea id=\"wpforms-10358-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-10358-field_24-error\" aria-describedby=\"wpforms-10358-field_24-description\" ><\/textarea><div id=\"wpforms-10358-field_24-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Fr\u00fchere Behandlungen<\/legend><ul id=\"wpforms-10358-field_20\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Physiotherapie\" aria-errormessage=\"wpforms-10358-field_20_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_20_1\">Physiotherapie<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_20_2\" name=\"wpforms[fields][20][]\" value=\"Chiropraktik\" aria-errormessage=\"wpforms-10358-field_20_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_20_2\">Chiropraktik<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_20_3\" name=\"wpforms[fields][20][]\" value=\"Osteopathie\" aria-errormessage=\"wpforms-10358-field_20_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_20_3\">Osteopathie<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_20_4\" name=\"wpforms[fields][20][]\" value=\"Atlastherapie\" aria-errormessage=\"wpforms-10358-field_20_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_20_4\">Atlastherapie<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_20_5\" name=\"wpforms[fields][20][]\" value=\"Atlasprofilax\u00ae\" aria-errormessage=\"wpforms-10358-field_20_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_20_5\">Atlasprofilax\u00ae<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_20_6\" name=\"wpforms[fields][20][]\" value=\"Massage\" aria-errormessage=\"wpforms-10358-field_20_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_20_6\">Massage<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_20_7\" name=\"wpforms[fields][20][]\" value=\"Akupunktur\" aria-errormessage=\"wpforms-10358-field_20_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_20_7\">Akupunktur<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_21-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_21\">Weitere fr\u00fchere Behandlungen<\/label><textarea id=\"wpforms-10358-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-10358-field_21-error\" aria-describedby=\"wpforms-10358-field_21-description\" ><\/textarea><div id=\"wpforms-10358-field_21-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_25-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">Darmgesundheit, wie h\u00e4ufig ist Ihr Stuhlgang?<\/legend><ul id=\"wpforms-10358-field_25\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_25_1\" name=\"wpforms[fields][25][]\" value=\"Mehrmals t\u00e4glich\" aria-errormessage=\"wpforms-10358-field_25_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_25_1\">Mehrmals t\u00e4glich<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_25_2\" name=\"wpforms[fields][25][]\" value=\"1\u00d7 t\u00e4glich\" aria-errormessage=\"wpforms-10358-field_25_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_25_2\">1\u00d7 t\u00e4glich<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_25_3\" name=\"wpforms[fields][25][]\" value=\"Alle 2 bis 3 Tage\" aria-errormessage=\"wpforms-10358-field_25_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_25_3\">Alle 2 bis 3 Tage<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_25_4\" name=\"wpforms[fields][25][]\" value=\"Seltener\" aria-errormessage=\"wpforms-10358-field_25_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_25_4\">Seltener<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_25_5\" name=\"wpforms[fields][25][]\" value=\"Wechselnd\" aria-errormessage=\"wpforms-10358-field_25_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_25_5\">Wechselnd<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_26-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"26\"><fieldset><legend class=\"wpforms-field-label\">Wie w\u00fcrden Sie Ihre Verdauung beschreiben?<\/legend><ul id=\"wpforms-10358-field_26\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_1\" name=\"wpforms[fields][26][]\" value=\"Unauff\u00e4llig\" aria-errormessage=\"wpforms-10358-field_26_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_1\">Unauff\u00e4llig<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_2\" name=\"wpforms[fields][26][]\" value=\"Verstopfung\" aria-errormessage=\"wpforms-10358-field_26_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_2\">Verstopfung<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_3\" name=\"wpforms[fields][26][]\" value=\"Durchfall\" aria-errormessage=\"wpforms-10358-field_26_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_3\">Durchfall<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_4\" name=\"wpforms[fields][26][]\" value=\"Wechsel zwischen Verstopfung und Durchfall\" aria-errormessage=\"wpforms-10358-field_26_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_4\">Wechsel zwischen Verstopfung und Durchfall<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_5\" name=\"wpforms[fields][26][]\" value=\"Bl\u00e4hungen\" aria-errormessage=\"wpforms-10358-field_26_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_5\">Bl\u00e4hungen<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_6\" name=\"wpforms[fields][26][]\" value=\"V\u00f6llegef\u00fchl\" aria-errormessage=\"wpforms-10358-field_26_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_6\">V\u00f6llegef\u00fchl<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_7\" name=\"wpforms[fields][26][]\" value=\"Bauchschmerzen\" aria-errormessage=\"wpforms-10358-field_26_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_7\">Bauchschmerzen<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_9\" name=\"wpforms[fields][26][]\" value=\"Sodbrennen\" aria-errormessage=\"wpforms-10358-field_26_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_9\">Sodbrennen<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_26_8\" name=\"wpforms[fields][26][]\" value=\"Kr\u00e4mpfe\" aria-errormessage=\"wpforms-10358-field_26_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_26_8\">Kr\u00e4mpfe<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_27-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">Wurden bei Ihnen folgende Erkrankungen diagnostiziert?<\/legend><ul id=\"wpforms-10358-field_27\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_27_1\" name=\"wpforms[fields][27][]\" value=\"Reizdarmsyndrom\" aria-errormessage=\"wpforms-10358-field_27_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_27_1\">Reizdarmsyndrom<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_27_2\" name=\"wpforms[fields][27][]\" value=\"Morbus Crohn\" aria-errormessage=\"wpforms-10358-field_27_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_27_2\">Morbus Crohn<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_27_3\" name=\"wpforms[fields][27][]\" value=\"Colitis ulcerosa\" aria-errormessage=\"wpforms-10358-field_27_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_27_3\">Colitis ulcerosa<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_27_4\" name=\"wpforms[fields][27][]\" value=\"Divertikulose \/ Divertikulitis\" aria-errormessage=\"wpforms-10358-field_27_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_27_4\">Divertikulose \/ Divertikulitis<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_27_5\" name=\"wpforms[fields][27][]\" value=\"Z\u00f6liakie\" aria-errormessage=\"wpforms-10358-field_27_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_27_5\">Z\u00f6liakie<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_27_6\" name=\"wpforms[fields][27][]\" value=\"Fruktoseintoleranz\" aria-errormessage=\"wpforms-10358-field_27_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_27_6\">Fruktoseintoleranz<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_27_7\" name=\"wpforms[fields][27][]\" value=\"Laktoseintoleranz\" aria-errormessage=\"wpforms-10358-field_27_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_27_7\">Laktoseintoleranz<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_27_8\" name=\"wpforms[fields][27][]\" value=\"Histaminintoleranz\" aria-errormessage=\"wpforms-10358-field_27_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_27_8\">Histaminintoleranz<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_28-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie in den letzten 12 Monaten Antibiotika eingenommen?<\/legend><ul id=\"wpforms-10358-field_28\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_28_1\" name=\"wpforms[fields][28][]\" value=\"Nein\" aria-errormessage=\"wpforms-10358-field_28_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_28_1\">Nein<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_28_2\" name=\"wpforms[fields][28][]\" value=\"Ja, 1\u00d7\" aria-errormessage=\"wpforms-10358-field_28_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_28_2\">Ja, 1\u00d7<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_28_3\" name=\"wpforms[fields][28][]\" value=\"Ja, mehrfach\" aria-errormessage=\"wpforms-10358-field_28_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_28_3\">Ja, mehrfach<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_29-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_29\">Gibt es bestimmte Lebensmittel, nach denen Beschwerden auftreten?<\/label><textarea id=\"wpforms-10358-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\" aria-errormessage=\"wpforms-10358-field_29-error\" ><\/textarea><\/div><div id=\"wpforms-10358-field_30-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_30\">Weitere Bemerkungen zur Verdauung oder Darmgesundheit:<\/label><textarea id=\"wpforms-10358-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" aria-errormessage=\"wpforms-10358-field_30-error\" aria-describedby=\"wpforms-10358-field_30-description\" ><\/textarea><div id=\"wpforms-10358-field_30-description\" class=\"wpforms-field-description\"><br \/><br \/><br \/><br \/><br \/><br \/><hr style=\"border-color:#448a85;\" \/><\/div><\/div><div id=\"wpforms-10358-field_31-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"31\"><fieldset><legend class=\"wpforms-field-label\">Psyche und Wohlbefinden, wie w\u00fcrden Sie Ihr aktuelles psychisches Wohlbefinden einsch\u00e4tzen?<\/legend><ul id=\"wpforms-10358-field_31\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_31_1\" name=\"wpforms[fields][31][]\" value=\"Sehr gut\" aria-errormessage=\"wpforms-10358-field_31_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_31_1\">Sehr gut<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_31_2\" name=\"wpforms[fields][31][]\" value=\"Gut\" aria-errormessage=\"wpforms-10358-field_31_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_31_2\">Gut<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_31_3\" name=\"wpforms[fields][31][]\" value=\"Mittelm\u00e4\u00dfig\" aria-errormessage=\"wpforms-10358-field_31_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_31_3\">Mittelm\u00e4\u00dfig<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_31_4\" name=\"wpforms[fields][31][]\" value=\"Belastet\" aria-errormessage=\"wpforms-10358-field_31_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_31_4\">Belastet<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_31_5\" name=\"wpforms[fields][31][]\" value=\"Stark belastet\" aria-errormessage=\"wpforms-10358-field_31_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_31_5\">Stark belastet<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_32-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"32\"><fieldset><legend class=\"wpforms-field-label\">F\u00fchlen Sie sich h\u00e4ufig gestresst?<\/legend><ul id=\"wpforms-10358-field_32\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_32_1\" name=\"wpforms[fields][32][]\" value=\"Nie\" aria-errormessage=\"wpforms-10358-field_32_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_32_1\">Nie<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_32_2\" name=\"wpforms[fields][32][]\" value=\"Selten\" aria-errormessage=\"wpforms-10358-field_32_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_32_2\">Selten<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_32_3\" name=\"wpforms[fields][32][]\" value=\"Gelegentlich\" aria-errormessage=\"wpforms-10358-field_32_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_32_3\">Gelegentlich<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_32_4\" name=\"wpforms[fields][32][]\" value=\"H\u00e4ufig\" aria-errormessage=\"wpforms-10358-field_32_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_32_4\">H\u00e4ufig<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_32_5\" name=\"wpforms[fields][32][]\" value=\"Fast immer\" aria-errormessage=\"wpforms-10358-field_32_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_32_5\">Fast immer<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_33-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"33\"><fieldset><legend class=\"wpforms-field-label\">Leider Sie unter Schlafbeschwerden?<\/legend><ul id=\"wpforms-10358-field_33\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_33_1\" name=\"wpforms[fields][33][]\" value=\"Einschlafst\u00f6rungen\" aria-errormessage=\"wpforms-10358-field_33_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_33_1\">Einschlafst\u00f6rungen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_33_2\" name=\"wpforms[fields][33][]\" value=\"Durchschlafst\u00f6rungen\" aria-errormessage=\"wpforms-10358-field_33_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_33_2\">Durchschlafst\u00f6rungen<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_33_3\" name=\"wpforms[fields][33][]\" value=\"Fr\u00fchem Erwachen\" aria-errormessage=\"wpforms-10358-field_33_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_33_3\">Fr\u00fchem Erwachen<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_33_4\" name=\"wpforms[fields][33][]\" value=\"Nicht erholsamem Schlaf\" aria-errormessage=\"wpforms-10358-field_33_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_33_4\">Nicht erholsamem Schlaf<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_33_5\" name=\"wpforms[fields][33][]\" value=\"Tagesm\u00fcdigkeit\" aria-errormessage=\"wpforms-10358-field_33_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_33_5\">Tagesm\u00fcdigkeit<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_33_6\" name=\"wpforms[fields][33][]\" value=\"Keine Schlafprobleme\" aria-errormessage=\"wpforms-10358-field_33_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_33_6\">Keine Schlafprobleme<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_34-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"34\"><fieldset><legend class=\"wpforms-field-label\">Haben Sie in den letzten 24 Monaten unter einer oder mehreren der folgenden Beschwerden oder Gegebenheiten gelitten?<\/legend><ul id=\"wpforms-10358-field_34\"><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_9\" name=\"wpforms[fields][34][]\" value=\"Schwerwiegendes Trauma\" aria-errormessage=\"wpforms-10358-field_34_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_9\">Schwerwiegendes Trauma<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_1\" name=\"wpforms[fields][34][]\" value=\"Beruflicher Stress\" aria-errormessage=\"wpforms-10358-field_34_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_1\">Beruflicher Stress<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_2\" name=\"wpforms[fields][34][]\" value=\"Famili\u00e4re Belastungen\" aria-errormessage=\"wpforms-10358-field_34_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_2\">Famili\u00e4re Belastungen<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_3\" name=\"wpforms[fields][34][]\" value=\"Trennung \/ Scheidung\" aria-errormessage=\"wpforms-10358-field_34_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_3\">Trennung \/ Scheidung<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_4\" name=\"wpforms[fields][34][]\" value=\"Verlust eines nahestehenden Menschen\" aria-errormessage=\"wpforms-10358-field_34_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_4\">Verlust eines nahestehenden Menschen<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_5\" name=\"wpforms[fields][34][]\" value=\"Schwere Krankheit\" aria-errormessage=\"wpforms-10358-field_34_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_5\">Schwere Krankheit<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_6\" name=\"wpforms[fields][34][]\" value=\"Pflege von Angeh\u00f6rigen\" aria-errormessage=\"wpforms-10358-field_34_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_6\">Pflege von Angeh\u00f6rigen<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_7\" name=\"wpforms[fields][34][]\" value=\"Sonstige Belastungen\" aria-errormessage=\"wpforms-10358-field_34_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_7\">Sonstige Belastungen<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_34_8\" name=\"wpforms[fields][34][]\" value=\"Keine besonderen Belastungen\" aria-errormessage=\"wpforms-10358-field_34_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_34_8\">Keine besonderen Belastungen<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_40-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"40\"><fieldset><legend class=\"wpforms-field-label\">Bitte geben Sie an, ob bei Ihnen seit Ihrer Geburt eine oder mehrere der folgenden Beschwerden, Erkrankungen oder gesundheitlichen Belastungen bestanden haben.<\/legend><ul id=\"wpforms-10358-field_40\"><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_9\" name=\"wpforms[fields][40][]\" value=\"Schwerwiegendes Trauma\" aria-errormessage=\"wpforms-10358-field_40_9-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_9\">Schwerwiegendes Trauma<\/label><\/li><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_1\" name=\"wpforms[fields][40][]\" value=\"Beruflicher Stress\" aria-errormessage=\"wpforms-10358-field_40_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_1\">Beruflicher Stress<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_2\" name=\"wpforms[fields][40][]\" value=\"Famili\u00e4re Belastungen\" aria-errormessage=\"wpforms-10358-field_40_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_2\">Famili\u00e4re Belastungen<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_3\" name=\"wpforms[fields][40][]\" value=\"Trennung \/ Scheidung\" aria-errormessage=\"wpforms-10358-field_40_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_3\">Trennung \/ Scheidung<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_4\" name=\"wpforms[fields][40][]\" value=\"Verlust eines nahestehenden Menschen\" aria-errormessage=\"wpforms-10358-field_40_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_4\">Verlust eines nahestehenden Menschen<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_5\" name=\"wpforms[fields][40][]\" value=\"Schwere Krankheit\" aria-errormessage=\"wpforms-10358-field_40_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_5\">Schwere Krankheit<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_6\" name=\"wpforms[fields][40][]\" value=\"Pflege von Angeh\u00f6rigen\" aria-errormessage=\"wpforms-10358-field_40_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_6\">Pflege von Angeh\u00f6rigen<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_7\" name=\"wpforms[fields][40][]\" value=\"Sonstige Belastungen\" aria-errormessage=\"wpforms-10358-field_40_7-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_7\">Sonstige Belastungen<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_40_8\" name=\"wpforms[fields][40][]\" value=\"Keine besonderen Belastungen\" aria-errormessage=\"wpforms-10358-field_40_8-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_40_8\">Keine besonderen Belastungen<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_35-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"35\"><fieldset><legend class=\"wpforms-field-label\">Nehmen Sie psychologische oder psychotherapeutische Unterst\u00fctzung in Anspruch?<\/legend><ul id=\"wpforms-10358-field_35\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_35_1\" name=\"wpforms[fields][35][]\" value=\"Nein\" aria-errormessage=\"wpforms-10358-field_35_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_35_1\">Nein<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_35_2\" name=\"wpforms[fields][35][]\" value=\"Ja, aktuell\" aria-errormessage=\"wpforms-10358-field_35_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_35_2\">Ja, aktuell<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_35_3\" name=\"wpforms[fields][35][]\" value=\"Ja, fr\u00fcher\" aria-errormessage=\"wpforms-10358-field_35_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_35_3\">Ja, fr\u00fcher<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_36-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"36\"><fieldset><legend class=\"wpforms-field-label\">Welche Faktoren beeinflussen Ihr Wohlbefinden besonders positiv?<\/legend><ul id=\"wpforms-10358-field_36\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_36_1\" name=\"wpforms[fields][36][]\" value=\"Bewegung\" aria-errormessage=\"wpforms-10358-field_36_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_36_1\">Bewegung<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_36_2\" name=\"wpforms[fields][36][]\" value=\"Sport\" aria-errormessage=\"wpforms-10358-field_36_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_36_2\">Sport<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_36_3\" name=\"wpforms[fields][36][]\" value=\"Natur\" aria-errormessage=\"wpforms-10358-field_36_3-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_36_3\">Natur<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_36_4\" name=\"wpforms[fields][36][]\" value=\"Familie\" aria-errormessage=\"wpforms-10358-field_36_4-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_36_4\">Familie<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_36_5\" name=\"wpforms[fields][36][]\" value=\"Freunde\" aria-errormessage=\"wpforms-10358-field_36_5-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_36_5\">Freunde<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-10358-field_36_6\" name=\"wpforms[fields][36][]\" value=\"Entspannungsverfahren\" aria-errormessage=\"wpforms-10358-field_36_6-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-10358-field_36_6\">Entspannungsverfahren<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-10358-field_38-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-10358-field_38\">Wie sch\u00e4tzen Sie 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width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\n<p class=\"wp-block-paragraph\">Mit * gekennzeichnete Felder sind Pflichtfelder.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Mit * gekennzeichnete Felder sind 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