{"id":272,"date":"2013-06-17T13:25:20","date_gmt":"2013-06-17T11:25:20","guid":{"rendered":"http:\/\/www.atlaspraxis.de\/?page_id=272"},"modified":"2026-02-15T13:31:00","modified_gmt":"2026-02-15T11:31:00","slug":"anmeldung","status":"publish","type":"page","link":"https:\/\/www.atlaspraxis.de\/en\/kontakt\/anmeldung\/","title":{"rendered":"Application"},"content":{"rendered":"<div class=\"wp-block-image\">\n<figure class=\"alignleft size-full is-resized\"><img loading=\"lazy\" decoding=\"async\" width=\"800\" height=\"800\" src=\"https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Info-4.png\" alt=\"Information\" class=\"wp-image-9882\" style=\"width:150px\" srcset=\"https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Info-4.png 800w, https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Info-4-600x600.png 600w, https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Info-4-150x150.png 150w, https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Info-4-768x768.png 768w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\" \/><\/figure>\n<\/div>\n\n\n<p>If you already have an appointment, you may send us some information in advance.<\/p>\n\n\n\n<div style=\"height:40px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wpforms-container wpforms-render-modern\" id=\"wpforms-8676\"><form id=\"wpforms-form-8676\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"8676\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/272\" data-token=\"43ddd67da93d064f8cabae29380a2e13\" data-token-time=\"1779764257\"><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-8676-field_9-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_9\">First name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8676-field_9\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-8676-field_9-error\" required><\/div><div id=\"wpforms-8676-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_5\">Last name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8676-field_5\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-8676-field_5-error\" required><\/div><div id=\"wpforms-8676-field_2-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_2\">E-mail address <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-8676-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" spellcheck=\"false\" aria-errormessage=\"wpforms-8676-field_2-error\" required><\/div><div id=\"wpforms-8676-field_14-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_14\">Phone number <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8676-field_14\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-8676-field_14-error\" required><\/div><div id=\"wpforms-8676-field_13-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_13\">Appointment <\/label><input type=\"text\" id=\"wpforms-8676-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-8676-field_13-error\" ><\/div><div id=\"wpforms-8676-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_15\">Date of Birth <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8676-field_15\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-8676-field_15-error\" required><\/div><div id=\"wpforms-8676-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_6\">Street <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8676-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-8676-field_6-error\" required><\/div><div id=\"wpforms-8676-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_12\">ZIP <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8676-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-8676-field_12-error\" required><\/div><div id=\"wpforms-8676-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_7\">City <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-8676-field_7\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-8676-field_7-error\" required><\/div>\t\t<div id=\"wpforms-8676-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-8676-field_1\" >Appointment Did number<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-8676-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-8676-field_8-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_8\">Country<\/label><input type=\"text\" id=\"wpforms-8676-field_8\" class=\"wpforms-field-medium\" name=\"wpforms[fields][8]\" aria-errormessage=\"wpforms-8676-field_8-error\" ><\/div><div id=\"wpforms-8676-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_16\">Occupation<\/label><input type=\"text\" id=\"wpforms-8676-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" aria-errormessage=\"wpforms-8676-field_16-error\" ><\/div><div id=\"wpforms-8676-field_3-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_3\">Medical complaints<\/label><textarea id=\"wpforms-8676-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" aria-errormessage=\"wpforms-8676-field_3-error\" ><\/textarea><\/div><div id=\"wpforms-8676-field_17-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_17\">Accidents<\/label><textarea id=\"wpforms-8676-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" aria-errormessage=\"wpforms-8676-field_17-error\" ><\/textarea><\/div><div id=\"wpforms-8676-field_18-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"18\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_18\">Spine problems<\/label><textarea id=\"wpforms-8676-field_18\" class=\"wpforms-field-medium\" name=\"wpforms[fields][18]\" aria-errormessage=\"wpforms-8676-field_18-error\" ><\/textarea><\/div><div id=\"wpforms-8676-field_19-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Are you pregnant at the time? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-8676-field_19\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8676-field_19_1\" name=\"wpforms[fields][19][]\" value=\"Yes\" aria-errormessage=\"wpforms-8676-field_19_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8676-field_19_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8676-field_19_2\" name=\"wpforms[fields][19][]\" value=\"No\" aria-errormessage=\"wpforms-8676-field_19_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8676-field_19_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-8676-field_19_3\" name=\"wpforms[fields][19][]\" value=\"Uncertain\" aria-errormessage=\"wpforms-8676-field_19_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8676-field_19_3\">Uncertain<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8676-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Did you have an Atlasprofilax method done before? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-8676-field_20\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-8676-field_20_1\" name=\"wpforms[fields][20][]\" value=\"Yes\" aria-errormessage=\"wpforms-8676-field_20_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8676-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-8676-field_20_2\" name=\"wpforms[fields][20][]\" value=\"No\" aria-errormessage=\"wpforms-8676-field_20_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8676-field_20_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-8676-field_20_3\" name=\"wpforms[fields][20][]\" value=\"Uncertain\" aria-errormessage=\"wpforms-8676-field_20_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8676-field_20_3\">Uncertain<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-8676-field_21-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-8676-field_21\">Notes<\/label><textarea id=\"wpforms-8676-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-8676-field_21-error\" ><\/textarea><\/div><div id=\"wpforms-8676-field_22-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-id=\"22\"><label class=\"wpforms-field-label\">GDPR consent <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><ul id=\"wpforms-8676-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-8676-field_22_1\" name=\"wpforms[fields][22][]\" value=\"I consent to this website storing the information I submit so that my inquiry can be answered.\" aria-errormessage=\"wpforms-8676-field_22_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-8676-field_22_1\">I consent to this website storing the information I submit so that my inquiry can be answered.<\/label><\/li><\/ul><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-8676-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-8676-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-8676-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha wpforms-is-recaptcha-type-v3\" ><input type=\"hidden\" name=\"wpforms[recaptcha]\" value=\"\"><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"8676\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/pages\/272\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-8676\" class=\"wpforms-submit\" data-alt-text=\"Wird gesendet\u00a0\u2026\" data-submit-text=\"Absenden\" aria-live=\"assertive\" value=\"wpforms-submit\">Absenden<\/button><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.atlaspraxis.de\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\n\n\n\n<p>You can also print out the application form and bring it with you when you are here for the appointment:<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-button-style-1\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/www.atlaspraxis.de\/wp-content\/uploads\/Anmeldung.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">PDF<\/a><\/div>\n<\/div>\n\n\n\n<p class=\"has-small-font-size\">By using this contact form you agree to our <a href=\"https:\/\/www.atlaspraxis.de\/en\/datenschutzerklaerung\/?lang=en\" target=\"_blank\" rel=\"noopener noreferrer\">privacy policy<\/a>. You also agree to the use of Google reCAPTCHA.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you already have an appointment, you may send us some information in advance. You can also print out the application form and bring it with you when you are here for the appointment: By using this contact form you agree to our privacy policy. You also agree to the use of Google reCAPTCHA.<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":153,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-272","page","type-page","status-publish","hentry"],"translation":{"provider":"WPGlobus","version":"3.0.2","language":"en","enabled_languages":["de","en"],"languages":{"de":{"title":true,"content":true,"excerpt":false},"en":{"title":true,"content":true,"excerpt":false}}},"_links":{"self":[{"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/pages\/272","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/comments?post=272"}],"version-history":[{"count":47,"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/pages\/272\/revisions"}],"predecessor-version":[{"id":9937,"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/pages\/272\/revisions\/9937"}],"up":[{"embeddable":true,"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/pages\/153"}],"wp:attachment":[{"href":"https:\/\/www.atlaspraxis.de\/en\/wp-json\/wp\/v2\/media?parent=272"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}