{"id":1193,"date":"2019-06-26T16:56:42","date_gmt":"2019-06-26T14:56:42","guid":{"rendered":"https:\/\/www.orthodontiemuseumplein.nl\/referrers\/"},"modified":"2019-06-26T17:13:54","modified_gmt":"2019-06-26T15:13:54","slug":"referrers","status":"publish","type":"page","link":"https:\/\/www.orthodontiemuseumplein.nl\/en\/referrers\/","title":{"rendered":"Referrers"},"content":{"rendered":"[mk_page_section bg_image=&#8221;https:\/\/www.orthodontiemuseumplein.nl\/wp-content\/uploads\/1000&#215;600-orthodontiemuseumplein-17.jpg&#8221; bg_repeat=&#8221;no-repeat&#8221; min_height=&#8221;600&#8243; full_width=&#8221;true&#8221; padding_top=&#8221;0&#8243; padding_bottom=&#8221;0&#8243; sidebar=&#8221;sidebar-1&#8243;][vc_column width=&#8221;1\/2&#8243;][\/vc_column][vc_column offset=&#8221;vc_col-lg-6 vc_col-md-12&#8243;][mk_padding_divider size=&#8221;150&#8243;][mk_padding_divider size=&#8221;150&#8243; visibility=&#8221;visible-nb&#8221;][mk_custom_box padding_vertical=&#8221;50&#8243; padding_horizental=&#8221;50&#8243; margin_bottom=&#8221;0&#8243; bg_color=&#8221;#f7f2ea&#8221;][mk_fancy_title tag_name=&#8221;h1&#8243; size=&#8221;72&#8243; force_font_size=&#8221;true&#8221; size_phone=&#8221;62&#8243; font_weight=&#8221;400&#8243; margin_bottom=&#8221;0&#8243; font_family=&#8221;none&#8221;]Referrers[\/mk_fancy_title][mk_fancy_title tag_name=&#8221;h1&#8243; color=&#8221;#cdcbcd&#8221; size=&#8221;32&#8243; force_font_size=&#8221;true&#8221; size_phone=&#8221;26&#8243; font_weight=&#8221;400&#8243; txt_transform=&#8221;uppercase&#8221; letter_spacing=&#8221;10&#8243; margin_bottom=&#8221;0&#8243; font_family=&#8221;Lato&#8221; font_type=&#8221;google&#8221;]Practice[\/mk_fancy_title][\/mk_custom_box][\/vc_column][\/mk_page_section][mk_page_section padding_top=&#8221;50&#8243; padding_bottom=&#8221;50&#8243; sidebar=&#8221;sidebar-1&#8243;][vc_column width=&#8221;1\/2&#8243;][mk_fancy_title size=&#8221;72&#8243; force_font_size=&#8221;true&#8221; size_phone=&#8221;62&#8243; font_weight=&#8221;400&#8243; margin_bottom=&#8221;0&#8243; font_family=&#8221;none&#8221;]Your reference[\/mk_fancy_title][mk_padding_divider][vc_column_text css=&#8221;.vc_custom_1540197609831{margin-bottom: 0px !important;}&#8221;]\n<div class=\"gmail_default\">You can refer your patients to Orthodontics Museumplein for all types of orthodontic treatments via the form below. You may also use your own referral method or give us a call at <a href=\"tel:0207235222\">020 723 5222<\/a>.<\/div>\n<div>In case you have any questions about planned or previous treatments of your patient, please give us a call or send us an email at <a href=\"mailto:lotte@orthodontiemuseumplein.nl\" target=\"_blank\" rel=\"noopener noreferrer\">lotte@<wbr \/>orthodontiemuseumplein.nl<\/a><\/div>\n[\/vc_column_text][\/vc_column][vc_column width=&#8221;1\/2&#8243;][\/vc_column][\/mk_page_section][mk_page_section bg_color=&#8221;#f7f2e9&#8243; bg_position=&#8221;center center&#8221; bg_repeat=&#8221;no-repeat&#8221; min_height=&#8221;0&#8243; padding_top=&#8221;100&#8243; padding_bottom=&#8221;100&#8243; sidebar=&#8221;sidebar-1&#8243;][vc_column width=&#8221;1\/6&#8243;][\/vc_column][vc_column width=&#8221;2\/3&#8243;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f1195-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"1195\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/1193#wpcf7-f1195-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contactformulier\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1195\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"nl_NL\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1195-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<h3>Your practice information\n<\/h3>\n<p><label> Name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"(first and last name)\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label>\n<\/p>\n<p><label> Practice*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"praktijk\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"praktijk\" \/><\/span> <\/label>\n<\/p>\n<p><label> Located in*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Plaats\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Amsterdam\" value=\"\" type=\"text\" name=\"Plaats\" \/><\/span> <\/label>\n<\/p>\n<p><label> Phone number*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telefoonnummer-tandarts\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"020 72 35 222\" value=\"\" type=\"tel\" name=\"telefoonnummer-tandarts\" \/><\/span><\/label>\n<\/p>\n<p><label> Email address*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span> <\/label>\n<\/p>\n<h3>Patient information\n<\/h3>\n<p><label> Name*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"naam-patient\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"first and last name\" value=\"\" type=\"text\" name=\"naam-patient\" \/><\/span> <\/label>\n<\/p>\n<p><label> Citizen service number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"bsn\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"bsn\" \/><\/span> <\/label>\n<\/p>\n<p><label> Date of birth*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"geboortedatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"DD\/MM\/YYYY\" value=\"\" type=\"text\" name=\"geboortedatum\" \/><\/span> <\/label>\n<\/p>\n<p><label> Adress*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Adres\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"street name and number\" value=\"\" type=\"text\" name=\"Adres\" \/><\/span> <\/label>\n<\/p>\n<p><label> Postal code \/ place of residence**<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Postcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"1234 AB Amsterdam\" value=\"\" type=\"text\" name=\"Postcode\" \/><\/span> <\/label>\n<\/p>\n<p><label> Phone number*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telefoonnummer-patient\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"telefoonnummer-patient\" \/><\/span> <\/label>\n<\/p>\n<p><label> Email address*<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email\" \/><\/span> <\/label>\n<\/p>\n<p><label> Name of insurer<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"verzekering\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"verzekering\" \/><\/span> <\/label>\n<\/p>\n<p><label> Registration number insurer<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"inschrijfnummer\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"inschrijfnummer\" \/><\/span> <\/label>\n<\/p>\n<h3>Additional information:\n<\/h3>\n<p><label> Topic, Message<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-subject\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-subject\" \/><\/span> <\/label>\n<\/p>\n<p><label> Message<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span> <\/label>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-874\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-874\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I hereby declare to have read, and agree with the storage, processing, and usage of the personal data that I have supplied under the conditions of the Orthodontics Museumplein privacy policy <a href=\"\nhttps:\/\/www.orthodontiemuseumplein.nl\/en\/privacy-policy\/\" target=\"_blank\"> Orthodontie Museumplein privacy policy * <\/a><\/span><\/label><\/span><\/span><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-737\"><span class=\"wpcf7-form-control wpcf7-acceptance optional\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-737\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I hereby declare that I have read the <a href=\"\nhttps:\/\/www.orthodontiemuseumplein.nl\/en\/general-terms-and-conditions\/\n\" target=\"_blank\">General Terms and Conditions<\/a> of Orthodontics Museumplein and that I will comply with them *<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p>\n<p><span id=\"wpcf7-6a2a9514ea8c9-wrapper\" class=\"wpcf7-form-control-wrap second-email-wrap\" style=\"display: block;\n\t\t    width: 0px;\n\t\t    height: 0px;\n\t\t    padding: 0px;\n\t\t    border: 1px solid transparent;\n\t\t    display: block;\n\t\t    overflow: hidden;\n\t\t    \"><input 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sidebar=&#8221;sidebar-1&#8243;][vc_column width=&#8221;1\/2&#8243;][\/vc_column][vc_column offset=&#8221;vc_col-lg-6 vc_col-md-12&#8243;][mk_padding_divider size=&#8221;150&#8243;][mk_padding_divider size=&#8221;150&#8243; visibility=&#8221;visible-nb&#8221;][mk_custom_box padding_vertical=&#8221;50&#8243; padding_horizental=&#8221;50&#8243; margin_bottom=&#8221;0&#8243; bg_color=&#8221;#f7f2ea&#8221;][mk_fancy_title tag_name=&#8221;h1&#8243; size=&#8221;72&#8243; force_font_size=&#8221;true&#8221; size_phone=&#8221;62&#8243; font_weight=&#8221;400&#8243; margin_bottom=&#8221;0&#8243; font_family=&#8221;none&#8221;]Referrers[\/mk_fancy_title][mk_fancy_title tag_name=&#8221;h1&#8243; color=&#8221;#cdcbcd&#8221; size=&#8221;32&#8243; force_font_size=&#8221;true&#8221; size_phone=&#8221;26&#8243; font_weight=&#8221;400&#8243; txt_transform=&#8221;uppercase&#8221; letter_spacing=&#8221;10&#8243; margin_bottom=&#8221;0&#8243; font_family=&#8221;Lato&#8221; font_type=&#8221;google&#8221;]Practice[\/mk_fancy_title][\/mk_custom_box][\/vc_column][\/mk_page_section][mk_page_section padding_top=&#8221;50&#8243; padding_bottom=&#8221;50&#8243; sidebar=&#8221;sidebar-1&#8243;][vc_column width=&#8221;1\/2&#8243;][mk_fancy_title size=&#8221;72&#8243; force_font_size=&#8221;true&#8221; size_phone=&#8221;62&#8243; font_weight=&#8221;400&#8243; margin_bottom=&#8221;0&#8243; font_family=&#8221;none&#8221;]Your reference[\/mk_fancy_title][mk_padding_divider][vc_column_text css=&#8221;.vc_custom_1540197609831{margin-bottom: 0px !important;}&#8221;] You can refer your patients [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1193","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ 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