{"id":15254,"date":"2026-08-06T10:28:23","date_gmt":"2026-08-06T08:28:23","guid":{"rendered":"https:\/\/dr-montanari.de\/?page_id=15254"},"modified":"2026-08-07T13:00:30","modified_gmt":"2026-08-07T11:00:30","slug":"medical-history","status":"publish","type":"page","link":"https:\/\/dr-montanari.de\/en\/anamnese\/","title":{"rendered":"Medical history"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"15254\" class=\"elementor elementor-15254\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-8ddb525 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"8ddb525\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-019f25a\" data-id=\"019f25a\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-6168309 elementor-widget elementor-widget-heading\" data-id=\"6168309\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Online-Anamnese\nPrivatpraxis Dr. Montanari<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-cb45017 elementor-widget elementor-widget-text-editor\" data-id=\"cb45017\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><strong>Sehr geehrte Patientin, sehr geehrter Patient! <\/strong><\/p><p>Willkommen in der Privatpraxis f\u00fcr Plastische und \u00c4sthetische Chirurgie von<span style=\"font-size: 1rem;\">Frau Dr. Michaela Montanari. <\/span>Um Sie optimal behandeln zu k\u00f6nnen, bitten wir Sie vor der ersten Vorstellung, nachfolgende Fragen\/Angaben gewissenhaft auszuf\u00fcllen.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4b3a0d5 elementor-widget elementor-widget-text-editor\" data-id=\"4b3a0d5\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p><span style=\"color: #ff0000;\">*<\/span> = Pflichtangabe<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-11394f0 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"11394f0\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-10a22be\" data-id=\"10a22be\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-7c565e8 elementor-section-content-middle elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"7c565e8\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-7c60056\" data-id=\"7c60056\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-c155f7e elementor-button-align-center elementor-mobile-button-align-center elementor-widget elementor-widget-form\" data-id=\"c155f7e\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;N\\u00e4chster&quot;,&quot;step_previous_label&quot;:&quot;Voriger&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" id=\"Kontakt_praxismontanari\" name=\"Online-Anamnese\" aria-label=\"Online-Anamnese\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"15254\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"c155f7e\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"\" \/>\n\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-above\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_7233f62 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Pers\u00f6nliche Angaben\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4beee8a elementor-col-50 elementor-sm-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4beee8a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tVorname\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4beee8a]\" id=\"form-field-field_4beee8a\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Vorname\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_aa17db7 elementor-col-50 elementor-sm-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_aa17db7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_aa17db7]\" id=\"form-field-field_aa17db7\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_5bfaa9d elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5bfaa9d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tStra\u00dfe, Nr.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_5bfaa9d]\" id=\"form-field-field_5bfaa9d\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Stra\u00dfe, Nr.\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_e586de6 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e586de6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPLZ, Ort\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_e586de6]\" id=\"form-field-field_e586de6\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"PLZ, Ort\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_57728dd elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_57728dd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tGeburtsdatum\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_57728dd]\" id=\"form-field-field_57728dd\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Geburtsdatum\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEmail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"f\u00fcr R\u00fcckfragen und diskrete Kommunikation und Terminbest\u00e4tigungen\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-b26ecb6 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-b26ecb6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTelefon\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[b26ecb6]\" id=\"form-field-b26ecb6\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Telefon\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_611fe34 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_611fe34\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHandy-Nr.\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_611fe34]\" id=\"form-field-field_611fe34\" class=\"elementor-field elementor-size-md  elementor-field-textual\" placeholder=\"Handy-Nr.\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_4149e9d elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4149e9d\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tR\u00fcckrufnummer von Angeh\u00f6rigen (Notfallkontakt)\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_4149e9d]\" id=\"form-field-field_4149e9d\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_c71818a elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_c71818a\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBeruf\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_c71818a]\" id=\"form-field-field_c71818a\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_ee7f8a9 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ee7f8a9\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHausarzt\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ee7f8a9]\" id=\"form-field-field_ee7f8a9\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_330df55 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_330df55\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tZuweisender Arzt\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_330df55]\" id=\"form-field-field_330df55\" class=\"elementor-field elementor-size-md  elementor-field-textual\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_5a74376 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5a74376\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tAbrechnung \u00fcber\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Selbstzahler\" id=\"form-field-field_5a74376-0\" name=\"form_fields[field_5a74376]\" required=\"required\"> <label for=\"form-field-field_5a74376-0\">Selbstzahler<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Privatversicherung\" id=\"form-field-field_5a74376-1\" name=\"form_fields[field_5a74376]\" required=\"required\"> <label for=\"form-field-field_5a74376-1\">Privatversicherung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Folgekostenversicherung\" id=\"form-field-field_5a74376-2\" name=\"form_fields[field_5a74376]\" required=\"required\"> <label for=\"form-field-field_5a74376-2\">Folgekostenversicherung<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_99dbf68 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_99dbf68\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tName der Versicherung\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_99dbf68]\" id=\"form-field-field_99dbf68\" rows=\"1\" placeholder=\"wenn PKV oder Folgekostenversicherung\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_7c0ccd2 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Besuchsgrund\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_85074b0 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_85074b0\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tFaltenbehandlung\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Botox\" id=\"form-field-field_85074b0-0\" name=\"form_fields[field_85074b0][]\"> <label for=\"form-field-field_85074b0-0\">Botox<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Filler\" id=\"form-field-field_85074b0-1\" name=\"form_fields[field_85074b0][]\"> <label for=\"form-field-field_85074b0-1\">Filler<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Skinbooster\" id=\"form-field-field_85074b0-2\" name=\"form_fields[field_85074b0][]\"> <label for=\"form-field-field_85074b0-2\">Skinbooster<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Operative Korrektur\" id=\"form-field-field_85074b0-3\" name=\"form_fields[field_85074b0][]\"> <label for=\"form-field-field_85074b0-3\">Operative Korrektur<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Hydra4Face\u00ae\" id=\"form-field-field_85074b0-4\" name=\"form_fields[field_85074b0][]\"> <label for=\"form-field-field_85074b0-4\">Hydra4Face\u00ae<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ultherapy\u00ae\" id=\"form-field-field_85074b0-5\" name=\"form_fields[field_85074b0][]\"> <label for=\"form-field-field_85074b0-5\">Ultherapy\u00ae<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sonstige\" id=\"form-field-field_85074b0-6\" name=\"form_fields[field_85074b0][]\"> <label for=\"form-field-field_85074b0-6\">Sonstige<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_b78add2 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b78add2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBereich Kopf & Gesicht\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Botox\" id=\"form-field-field_b78add2-0\" name=\"form_fields[field_b78add2][]\"> <label for=\"form-field-field_b78add2-0\">Botox<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Filler\" id=\"form-field-field_b78add2-1\" name=\"form_fields[field_b78add2][]\"> <label for=\"form-field-field_b78add2-1\">Filler<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Lipofilling\" id=\"form-field-field_b78add2-2\" name=\"form_fields[field_b78add2][]\"> <label for=\"form-field-field_b78add2-2\">Lipofilling<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Skinbooster\" id=\"form-field-field_b78add2-3\" name=\"form_fields[field_b78add2][]\"> <label for=\"form-field-field_b78add2-3\">Skinbooster<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Hydra4Face\u00ae\" id=\"form-field-field_b78add2-4\" name=\"form_fields[field_b78add2][]\"> <label for=\"form-field-field_b78add2-4\">Hydra4Face\u00ae<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Ultherapy\u00ae\" id=\"form-field-field_b78add2-5\" name=\"form_fields[field_b78add2][]\"> <label for=\"form-field-field_b78add2-5\">Ultherapy\u00ae<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sonstige\" id=\"form-field-field_b78add2-6\" name=\"form_fields[field_b78add2][]\"> <label for=\"form-field-field_b78add2-6\">Sonstige<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_651924c elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_651924c\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tBrust\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Brustwarzenkorrektur\" id=\"form-field-field_651924c-0\" name=\"form_fields[field_651924c][]\"> <label for=\"form-field-field_651924c-0\">Brustwarzenkorrektur<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Brustverkleinerung\" id=\"form-field-field_651924c-1\" name=\"form_fields[field_651924c][]\"> <label for=\"form-field-field_651924c-1\">Brustverkleinerung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Brustvergr\u00f6\u00dferung\" id=\"form-field-field_651924c-2\" name=\"form_fields[field_651924c][]\"> <label for=\"form-field-field_651924c-2\">Brustvergr\u00f6\u00dferung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Bruststraffung\" id=\"form-field-field_651924c-3\" name=\"form_fields[field_651924c][]\"> <label for=\"form-field-field_651924c-3\">Bruststraffung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Implantatentfernung\" id=\"form-field-field_651924c-4\" name=\"form_fields[field_651924c][]\"> <label for=\"form-field-field_651924c-4\">Implantatentfernung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Implantatwechsel\" id=\"form-field-field_651924c-5\" name=\"form_fields[field_651924c][]\"> <label for=\"form-field-field_651924c-5\">Implantatwechsel<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Schlupfwarzenkorrektur\" id=\"form-field-field_651924c-6\" name=\"form_fields[field_651924c][]\"> <label for=\"form-field-field_651924c-6\">Schlupfwarzenkorrektur<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_adc9819 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_adc9819\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tK\u00f6rper\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Cellulite\" id=\"form-field-field_adc9819-0\" name=\"form_fields[field_adc9819][]\"> <label for=\"form-field-field_adc9819-0\">Cellulite<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Fettabsaugung \" id=\"form-field-field_adc9819-1\" name=\"form_fields[field_adc9819][]\"> <label for=\"form-field-field_adc9819-1\">Fettabsaugung <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Hautstraffung\" id=\"form-field-field_adc9819-2\" name=\"form_fields[field_adc9819][]\"> <label for=\"form-field-field_adc9819-2\">Hautstraffung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Lip\u00f6dem\" id=\"form-field-field_adc9819-3\" name=\"form_fields[field_adc9819][]\"> <label for=\"form-field-field_adc9819-3\">Lip\u00f6dem<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Mommy Makeover\" id=\"form-field-field_adc9819-4\" name=\"form_fields[field_adc9819][]\"> <label for=\"form-field-field_adc9819-4\">Mommy Makeover<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sonstige\" id=\"form-field-field_adc9819-5\" name=\"form_fields[field_adc9819][]\"> <label for=\"form-field-field_adc9819-5\">Sonstige<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_71fb695 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_71fb695\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIntimkorrketur\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Schamlippenverkleinerung\" id=\"form-field-field_71fb695-0\" name=\"form_fields[field_71fb695][]\"> <label for=\"form-field-field_71fb695-0\">Schamlippenverkleinerung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Schamlippenvergr\u00f6\u00dferung\" id=\"form-field-field_71fb695-1\" name=\"form_fields[field_71fb695][]\"> <label for=\"form-field-field_71fb695-1\">Schamlippenvergr\u00f6\u00dferung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Scheidentrockenheit  \" id=\"form-field-field_71fb695-2\" name=\"form_fields[field_71fb695][]\"> <label for=\"form-field-field_71fb695-2\">Scheidentrockenheit  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Nicht-operative Intim\u00e4sthetik\" id=\"form-field-field_71fb695-3\" name=\"form_fields[field_71fb695][]\"> <label for=\"form-field-field_71fb695-3\">Nicht-operative Intim\u00e4sthetik<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Venush\u00fcgel-Korrektur  \" id=\"form-field-field_71fb695-4\" name=\"form_fields[field_71fb695][]\"> <label for=\"form-field-field_71fb695-4\">Venush\u00fcgel-Korrektur  <\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_ed18089 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ed18089\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSonstiger Besuchsgrund\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_ed18089]\" id=\"form-field-field_ed18089\" rows=\"2\" placeholder=\"Wenn Sie oben Sonstige ausgew\u00e4hlt haben oder Ihr Thema nicht aufgef\u00fchrt ist.\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_d79d1a3 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Einverst\u00e4ndnis-erkl\u00e4rung\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_7ee8cf2 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_7ee8cf2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tErkl\u00e4rung\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_7ee8cf2]\" id=\"form-field-field_7ee8cf2\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_7ee8cf2\">Ich m\u00f6chte von Frau Dr. med. Michaela Montanari und\/oder Frau Dr. med. Anna Maria Bugariu \u00e4rztlich untersuchen, beraten und behandelt werden.<br><br>\n\nIch bin dar\u00fcber informiert und erkl\u00e4re mich damit einverstanden, dass ich als Privatversicherte(r) Patientin \/ Patient oder Selbstzahler\/in einen direkten Vertrag mit der\/den behandelnden \u00c4rztin\/\u00c4rztinnen abschlie\u00dfe. <br><br>\nEs besteht somit keine vertragliche Bindung zwischen der \u00c4rztin und der privaten Krankenversicherung bzw. \/ (und) der Beihilfe. Die Angemessenheit des Honorars richtet sich individuell nach der Schwere des Krankheitsbildes sowie dem medizinischen bez. \u00c4sthetischen Beratungs- und Behandlungsaufwand. <br><br>\nJe nach Aufwand k\u00f6nnen demnach bei der Rechnungsstellung auch h\u00f6here Steigerungss\u00e4tze als Faktor 2,3x oder Faktor 3,5x der Geb\u00fchrenordnung f\u00fcr \u00c4rzte Anwendung finden. \nNach \u00a7 12 Abs. 1 der GO\u00c4 wird der Rechnungsbetrag nach Erhalt der Liquidation in voller H\u00f6he f\u00e4llig \u2013 unabh\u00e4ngig vom Erstattungsbetrag der privaten Versicherung bzw. \/ (und) der Beihilfestelle.<br><br>\nWir weisen darauf hin, dass wir nicht garantieren k\u00f6nnen, dass die Beihilfestelle und\/oder die Private Krankenversicherung die Behandlungskosten vollst\u00e4ndig \u00fcbernehmen werden. Gerne stellen wir f\u00fcr Sie vor Beginn einer gr\u00f6\u00dferen Behandlung einen Kostenvoranschlag als \u00dcbernahmeantrag.<br><br>\nEine Erf\u00fcllung der Honorarforderung durch Abtretung des gegen\u00fcber der privaten Krankenversicherung oder der Beihilfestelle des Patienten bestehenden Erstattungsanspruchs wird ausgeschlossen. Der Patient ist dar\u00fcber informiert, dass die Krankenkasse\/Beihilfestelle die Erstattung des Rechnungsbetrages ganz oder teilweise ablehnen kann.<br><br>\nMir ist bekannt, dass ich z. B. bei Krankheit vereinbarte Behandlungs- oder Operationstermine sp\u00e4testens 3 Arbeitstage vorher absagen muss, da mir sonst die vorgesehene Leistung bzw. die ungenutzte Zeit in Rechnung gestellt wird (\u00a7\u00a7 304, 615 BGB).\nUntersuchung, Beratung und Behandlung beginnen nach Unterzeichnung dieser Vereinbarung.\n<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_e264ca7 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Wie wurden Sie auf uns aufmerksam?\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_5c2bf3f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_5c2bf3f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDie Praxis wurde mir empfohlen:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Arzt-Empfehlung\" id=\"form-field-field_5c2bf3f-0\" name=\"form_fields[field_5c2bf3f][]\"> <label for=\"form-field-field_5c2bf3f-0\">Arzt-Empfehlung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Privat-Empfehlung \" id=\"form-field-field_5c2bf3f-1\" name=\"form_fields[field_5c2bf3f][]\"> <label for=\"form-field-field_5c2bf3f-1\">Privat-Empfehlung <\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Jameda\" id=\"form-field-field_5c2bf3f-2\" name=\"form_fields[field_5c2bf3f][]\"> <label for=\"form-field-field_5c2bf3f-2\">Jameda<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"KI\" id=\"form-field-field_5c2bf3f-3\" name=\"form_fields[field_5c2bf3f][]\"> <label for=\"form-field-field_5c2bf3f-3\">KI<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Soziale Medien\" id=\"form-field-field_5c2bf3f-4\" name=\"form_fields[field_5c2bf3f][]\"> <label for=\"form-field-field_5c2bf3f-4\">Soziale Medien<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Rezensionen\" id=\"form-field-field_5c2bf3f-5\" name=\"form_fields[field_5c2bf3f][]\"> <label for=\"form-field-field_5c2bf3f-5\">Rezensionen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sonstiges\" id=\"form-field-field_5c2bf3f-6\" name=\"form_fields[field_5c2bf3f][]\"> <label for=\"form-field-field_5c2bf3f-6\">Sonstiges<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_fc40ff8 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_fc40ff8\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWenn Sonstiges oder Empfehlung durch \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_fc40ff8]\" id=\"form-field-field_fc40ff8\" rows=\"1\" placeholder=\"Wer hat uns empfohlen? Bitte erg\u00e4nzen\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-checkbox elementor-field-group elementor-column elementor-field-group-field_e264ca7 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e264ca7\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWie wurden Sie auf uns aufmerksam?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Webseite dr-montanari.de\" id=\"form-field-field_e264ca7-0\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-0\">Webseite dr-montanari.de<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Webseite schamlippenverkleinerung-nrw.de\" id=\"form-field-field_e264ca7-1\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-1\">Webseite schamlippenverkleinerung-nrw.de<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Facebook\/Instagram\" id=\"form-field-field_e264ca7-2\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-2\">Facebook\/Instagram<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"TikTok\" id=\"form-field-field_e264ca7-3\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-3\">TikTok<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"mybody.de\" id=\"form-field-field_e264ca7-4\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-4\">mybody.de<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"premiumpraxen.de\" id=\"form-field-field_e264ca7-5\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-5\">premiumpraxen.de<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Jameda\" id=\"form-field-field_e264ca7-6\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-6\">Jameda<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Google\" id=\"form-field-field_e264ca7-7\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-7\">Google<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Printmedien\" id=\"form-field-field_e264ca7-8\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-8\">Printmedien<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Online-Medien\" id=\"form-field-field_e264ca7-9\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-9\">Online-Medien<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"TV-Beitrag\/Radio\" id=\"form-field-field_e264ca7-10\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-10\">TV-Beitrag\/Radio<\/label><\/span><span class=\"elementor-field-option\"><input type=\"checkbox\" value=\"Sonstiges\" id=\"form-field-field_e264ca7-11\" name=\"form_fields[field_e264ca7][]\"> <label for=\"form-field-field_e264ca7-11\">Sonstiges<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_e726d38 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_e726d38\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWenn Sonstiges bitte erl\u00e4utern\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_e726d38]\" id=\"form-field-field_e726d38\" rows=\"1\" placeholder=\"Wer hat uns empfohlen? Bitte erg\u00e4nzen\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_38ccb8a elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Vorerkrangungen\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_526dd13 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_526dd13\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tLeiden Sie an einer oder mehreren folgenden Erkrankungen?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"keine Erkrankungen bzw. keine Beschwerden bekannt\" id=\"form-field-field_526dd13-0\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-0\">keine Erkrankungen bzw. keine Beschwerden bekannt<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Diabetes mellitus\" id=\"form-field-field_526dd13-1\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-1\">Diabetes mellitus<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Bluthochdruck\" id=\"form-field-field_526dd13-2\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-2\">Bluthochdruck<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Wundheilungsst\u00f6rungen\" id=\"form-field-field_526dd13-3\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-3\">Wundheilungsst\u00f6rungen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Infektionen (z.B. Hepatitis, HIV)\" id=\"form-field-field_526dd13-4\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-4\">Infektionen (z.B. Hepatitis, HIV)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Rezidivierender Herpes\" id=\"form-field-field_526dd13-5\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-5\">Rezidivierender Herpes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Schilddr\u00fcsenerkrankung\" id=\"form-field-field_526dd13-6\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-6\">Schilddr\u00fcsenerkrankung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"rheumatische Beschwerden\" id=\"form-field-field_526dd13-7\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-7\">rheumatische Beschwerden<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Neigung zu \u00fcberschie\u00dfender Narbenbildung \" id=\"form-field-field_526dd13-8\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-8\">Neigung zu \u00fcberschie\u00dfender Narbenbildung <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Erkrankungen an Herz, Niere, Magendarm oder Leber\" id=\"form-field-field_526dd13-9\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-9\">Erkrankungen an Herz, Niere, Magendarm oder Leber<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Autoimmunerkrankungen\" id=\"form-field-field_526dd13-10\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-10\">Autoimmunerkrankungen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Neurologische oder psychische Erkrankungen\" id=\"form-field-field_526dd13-11\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-11\">Neurologische oder psychische Erkrankungen<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Lungenerkrankungen (z.B. Asthma)\t\" id=\"form-field-field_526dd13-12\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-12\">Lungenerkrankungen (z.B. Asthma)\t<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Krebsleiden\" id=\"form-field-field_526dd13-13\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-13\">Krebsleiden<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Sind Sie schwanger oder stillen Sie?\t\" id=\"form-field-field_526dd13-14\" name=\"form_fields[field_526dd13]\" required=\"required\"> <label for=\"form-field-field_526dd13-14\">Sind Sie schwanger oder stillen Sie?\t<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_84b0bcc elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_84b0bcc\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSonstiges Erkrankungen:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_84b0bcc]\" id=\"form-field-field_84b0bcc\" rows=\"1\" placeholder=\"bitte erg\u00e4nzen\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_9369f37 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9369f37\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHaben Sie Allergieen?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"keine Allgergie bekannt\" id=\"form-field-field_9369f37-0\" name=\"form_fields[field_9369f37]\" required=\"required\"> <label for=\"form-field-field_9369f37-0\">keine Allgergie bekannt<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Antibiotika\" id=\"form-field-field_9369f37-1\" name=\"form_fields[field_9369f37]\" required=\"required\"> <label for=\"form-field-field_9369f37-1\">Antibiotika<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Lidocain\/Tetracain\" id=\"form-field-field_9369f37-2\" name=\"form_fields[field_9369f37]\" required=\"required\"> <label for=\"form-field-field_9369f37-2\">Lidocain\/Tetracain<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Kortision\" id=\"form-field-field_9369f37-3\" name=\"form_fields[field_9369f37]\" required=\"required\"> <label for=\"form-field-field_9369f37-3\">Kortision<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Sonstige\" id=\"form-field-field_9369f37-4\" name=\"form_fields[field_9369f37]\" required=\"required\"> <label for=\"form-field-field_9369f37-4\">Sonstige<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_9358da4 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9358da4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tErg\u00e4nzung \/ Bemerkung Allgergien\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_9358da4]\" id=\"form-field-field_9358da4\" rows=\"3\" placeholder=\"Bitte entsprechend erg\u00e4nzen\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_f52c934 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Vorbehandlung\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_16571bd elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_16571bd\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSind Sie schon einmal oder mehrmals \u00e4sthetisch operiert\/behandelt worden? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"bisher wurde ich noch nicht \u00e4sthetisch behandelt\" id=\"form-field-field_16571bd-0\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-0\">bisher wurde ich noch nicht \u00e4sthetisch behandelt<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Botox\" id=\"form-field-field_16571bd-1\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-1\">Botox<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Filler\" id=\"form-field-field_16571bd-2\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-2\">Filler<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Facelifting\" id=\"form-field-field_16571bd-3\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-3\">Facelifting<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Augenlidkorrektur\" id=\"form-field-field_16571bd-4\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-4\">Augenlidkorrektur<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Laserbehandlung\" id=\"form-field-field_16571bd-5\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-5\">Laserbehandlung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Nasenkorrektur  \" id=\"form-field-field_16571bd-6\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-6\">Nasenkorrektur  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Brustvergr\u00f6\u00dferung \" id=\"form-field-field_16571bd-7\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-7\">Brustvergr\u00f6\u00dferung <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Brustverkleinerung\/-Straffung      \" id=\"form-field-field_16571bd-8\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-8\">Brustverkleinerung\/-Straffung      <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Fettabsaugung \" id=\"form-field-field_16571bd-9\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-9\">Fettabsaugung <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Bauchdeckenstraffung    \" id=\"form-field-field_16571bd-10\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-10\">Bauchdeckenstraffung    <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Oberarm-\/Oberschenkelstraffung  \" id=\"form-field-field_16571bd-11\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-11\">Oberarm-\/Oberschenkelstraffung  <\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Intimchirurgie\" id=\"form-field-field_16571bd-12\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-12\">Intimchirurgie<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Sonstige\" id=\"form-field-field_16571bd-13\" name=\"form_fields[field_16571bd]\" required=\"required\"> <label for=\"form-field-field_16571bd-13\">Sonstige<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_aac884f elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_aac884f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tErg\u00e4nzung \u00c4sthetische Behandlungen:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_aac884f]\" id=\"form-field-field_aac884f\" rows=\"1\" placeholder=\"Bitte erg\u00e4nzen Sie (z. B. wann wurde der Eingriff durchgef\u00fchrt, welcher Eingriff (wenn nicht aufgef\u00fchhrt), etc.)\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_ade6656 elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_ade6656\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSind andere (medizinische) Operationen durchgef\u00fchrt worden? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_ade6656]\" id=\"form-field-field_ade6656\" rows=\"2\" placeholder=\"Wenn ja, welche und wann wurde der Eingriff durchgef\u00fchrt?\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_9369f37 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_9369f37\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHaben Sie je bei einer Operation\/beim Zahnarzt eine Lokale An\u00e4sthesie erhalten?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_9369f37]\" id=\"form-field-field_9369f37\" class=\"elementor-field-textual elementor-size-md\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option type=\"radio\" value=\"keine Allgergie bekannt nein\" id=\"form-field-field_9369f37-0\" name=\"form_fields[field_9369f37]\" required=\"required\">nein<\/option>\n\t\t\t\t\t\t\t\t\t<option type=\"radio\" value=\"Antibiotika ja und ich habe sie gut vertragen\" id=\"form-field-field_9369f37-1\" name=\"form_fields[field_9369f37]\" required=\"required\">ja und ich habe sie gut vertragen<\/option>\n\t\t\t\t\t\t\t\t\t<option type=\"radio\" value=\"Lidocain\/Tetracain ja - aber es gab Probleme\" id=\"form-field-field_9369f37-2\" name=\"form_fields[field_9369f37]\" required=\"required\">ja - aber es gab Probleme<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_4155ef4 elementor-col-50 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4155ef4\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tHatten Sie nach einem operativen Eingriff Komplikationen?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"nein\" id=\"form-field-field_4155ef4-0\" name=\"form_fields[field_4155ef4]\" required=\"required\"> <label for=\"form-field-field_4155ef4-0\">nein<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"erh\u00f6hte Blutungsneigung\/Nachblutung\" id=\"form-field-field_4155ef4-1\" name=\"form_fields[field_4155ef4]\" required=\"required\"> <label for=\"form-field-field_4155ef4-1\">erh\u00f6hte Blutungsneigung\/Nachblutung<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Thrombose\" id=\"form-field-field_4155ef4-2\" name=\"form_fields[field_4155ef4]\" required=\"required\"> <label for=\"form-field-field_4155ef4-2\">Thrombose<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Andere\" id=\"form-field-field_4155ef4-3\" name=\"form_fields[field_4155ef4]\" required=\"required\"> <label for=\"form-field-field_4155ef4-3\">Andere<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_faabc75 elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_faabc75\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tErg\u00e4nzung Komplikationen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_faabc75]\" id=\"form-field-field_faabc75\" rows=\"2\" placeholder=\"Wenn ja, welche und wann?\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_611fbd0 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Medikamente\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_bdd9c89 elementor-col-60 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_bdd9c89\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWelche Medikamente nehmen Sie regelm\u00e4\u00dfig in welcher Dosierung ein? \t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  \"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"keine\" id=\"form-field-field_bdd9c89-0\" name=\"form_fields[field_bdd9c89]\" required=\"required\"> <label for=\"form-field-field_bdd9c89-0\">keine<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Aspirin\" id=\"form-field-field_bdd9c89-1\" name=\"form_fields[field_bdd9c89]\" required=\"required\"> <label for=\"form-field-field_bdd9c89-1\">Aspirin<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Marcumar\" id=\"form-field-field_bdd9c89-2\" name=\"form_fields[field_bdd9c89]\" required=\"required\"> <label for=\"form-field-field_bdd9c89-2\">Marcumar<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Kontrazeptiva (Verh\u00fctungspille)\" id=\"form-field-field_bdd9c89-3\" name=\"form_fields[field_bdd9c89]\" required=\"required\"> <label for=\"form-field-field_bdd9c89-3\">Kontrazeptiva (Verh\u00fctungspille)<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Hochdosierte Vitamine\" id=\"form-field-field_bdd9c89-4\" name=\"form_fields[field_bdd9c89]\" required=\"required\"> <label for=\"form-field-field_bdd9c89-4\">Hochdosierte Vitamine<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Sonstige\" id=\"form-field-field_bdd9c89-5\" name=\"form_fields[field_bdd9c89]\" required=\"required\"> <label for=\"form-field-field_bdd9c89-5\">Sonstige<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_093f3a3 elementor-col-40\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_093f3a3\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tErg\u00e4nzung \/ Bemerkung Medikamente\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_093f3a3]\" id=\"form-field-field_093f3a3\" rows=\"4\" placeholder=\"Bitte entsprechend erg\u00e4nzen\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_a8b12ea elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Sonstiges\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_58e260e elementor-col-25 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_58e260e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tSind Sie Raucher?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_58e260e]\" id=\"form-field-field_58e260e\" class=\"elementor-field-textual elementor-size-md\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Ja\">Ja<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Nein\">Nein<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_b701d5e elementor-col-25\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b701d5e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tWenn ja:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_b701d5e]\" id=\"form-field-field_b701d5e\" rows=\"1\" placeholder=\"Zigaretten pro Tag \"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_b52d6e5 elementor-col-25 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_b52d6e5\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tTrinken Sie regelm\u00e4\u00dfig Alkohol?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_b52d6e5]\" id=\"form-field-field_b52d6e5\" class=\"elementor-field-textual elementor-size-md\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"nein\">nein<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"selten\">selten<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"1 mal w\u00f6chentlich\">1 mal w\u00f6chentlich<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"2-3 mal w\u00f6chentlich\">2-3 mal w\u00f6chentlich<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"t\u00e4glich\">t\u00e4glich<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-field_f6fbaa6 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f6fbaa6\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tNeigen Sie zu blauen Flecken?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-eicon-caret-down\" viewBox=\"0 0 571.4 571.4\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M571 393Q571 407 561 418L311 668Q300 679 286 679T261 668L11 418Q0 407 0 393T11 368 36 357H536Q550 357 561 368T571 393Z\"><\/path><\/svg>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[field_f6fbaa6]\" id=\"form-field-field_f6fbaa6\" class=\"elementor-field-textual elementor-size-md\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"\"><\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"nein\">nein<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"ja\">ja<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_2de2043 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2de2043\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIhre K\u00f6rpergr\u00f6\u00dfe\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_2de2043]\" id=\"form-field-field_2de2043\" rows=\"1\" placeholder=\"in cm\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-field_2a5fef2 elementor-col-33 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2a5fef2\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tIhr Gewicht\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-md\" name=\"form_fields[field_2a5fef2]\" id=\"form-field-field_2a5fef2\" rows=\"1\" placeholder=\"in kg\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_9510d60 elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Datenschutz\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_3174881 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_3174881\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEinwilligung Verarbeitung\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_3174881]\" id=\"form-field-field_3174881\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_3174881\">Ich habe die <a href=\"https:\/\/dr-montanari.de\/kontakt\/datenschutz\/\">Datenschutzerkl\u00e4rung<\/a> zur Kenntnis genommen und bin damit einverstanden:<br><br>\n\nEINWILLIGUNG in die Verarbeitung personenbezogener Daten, Honorarvertrag und Fragebogen\ndurch die Privatpraxis Dr. Michaela Montanari in einer \u00e4rztlichen Praxis ist die Erhebung und Verarbeitung personenbezogener Daten die Voraussetzung f\u00fcr eine sorgf\u00e4ltige Behandlung, f\u00fcr die nach der Datenschutzgrundverordnung ab dem 25.05.2018 Ihre Einwilligung erforderlich ist. <br><br>\nDie Art der verarbeitenden Daten, der Umfang der Verarbeitung und m\u00f6gliche Empf\u00e4nger sind in allen F\u00e4llen auf das f\u00fcr den jeweiligen Zweck Erforderliche beschr\u00e4nkt. Die Daten werden nach Zweckerf\u00fcllung gel\u00f6scht, soweit keine gesetzliche Aufbewahrungspflicht besteht oder sich eine andere Notwendigkeit zur Speicherung aus der Behandlung selbst ergibt. <br><br>\nMit unserer \u201ePatienteninformation zum Datenschutz\u201c wurden Sie darauf hingewiesen, dass wir Ihre Daten an Dritte nur dann weitergeben d\u00fcrfen, sofern dies gesetzlich vorgesehen ist oder wir Ihre Einwilligung erhalten haben. Um Ihre Daten im Zusammenhang mit Ihrer Behandlung an weitere Leistungserbringer (z.B. andere \u00c4rzte, Krankenh\u00e4user, Labore) \u00fcbermitteln zu d\u00fcrfen (z.B. mittels Arztbrief), bedarf es Ihrer Einwilligung. Ohne diese ist uns eine ad\u00e4quate Information der Nachbehandler und Dienstleistungs-erbringer nicht m\u00f6glich. Sie m\u00fcssen dann ggf. selber die notwendigen Informationen liefern. \n<br><br>\nWir m\u00f6chten Sie bitten, durch Ihre Unterschrift zu best\u00e4tigen, dass sie mit den genannten Verarbeitungen Ihrer Daten einverstanden sind. Sie haben die M\u00f6glichkeit, jede Einwilligung, jederzeit durch formlose Mitteilung an uns, zu widerrufen.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-step elementor-field-group elementor-column elementor-field-group-field_70c8d3f elementor-col-100\">\n\t\t\t\t\t\t\t<div class=\"e-field-step elementor-hidden\" data-label=\"Datenweitergabe\" data-previousButton=\"\" data-nextButton=\"\" data-iconUrl=\"\" data-iconLibrary=\"fas fa-star\" data-icon=\"&lt;svg class=&quot;e-font-icon-svg e-fas-star&quot; viewBox=&quot;0 0 576 512&quot; xmlns=&quot;http:\/\/www.w3.org\/2000\/svg&quot;&gt;&lt;path d=&quot;M259.3 17.8L194 150.2 47.9 171.5c-26.2 3.8-36.7 36.1-17.7 54.6l105.7 103-25 145.5c-4.5 26.3 23.2 46 46.4 33.7L288 439.6l130.7 68.7c23.2 12.2 50.9-7.4 46.4-33.7l-25-145.5 105.7-103c19-18.5 8.5-50.8-17.7-54.6L382 150.2 316.7 17.8c-11.7-23.6-45.6-23.9-57.4 0z&quot;&gt;&lt;\/path&gt;&lt;\/svg&gt;\" ><\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-acceptance elementor-field-group elementor-column elementor-field-group-field_60d8655 elementor-col-100 elementor-field-required elementor-mark-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_60d8655\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tEinwilligung Datenweitergabe\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-subgroup\">\n\t\t\t<span class=\"elementor-field-option\">\n\t\t\t\t<input type=\"checkbox\" name=\"form_fields[field_60d8655]\" id=\"form-field-field_60d8655\" class=\"elementor-field elementor-size-md  elementor-acceptance-field\" required=\"required\">\n\t\t\t\t<label for=\"form-field-field_60d8655\">Ich bin damit einverstanden:<br><br>\n\nEINWILLIGUNG IN DIE DATENWEITERGABE UND Datenverarbeitung <br><br>\nHiermit willige ich ein, , dass Daten \u00fcber die \u00e4rztliche Behandlung in der Privatpraxis  Dr. Michaela Montanari weitergegeben werden d\u00fcrfen:<br><br>\n1.\tim Rahmen der online-Terminvereinbarung an die Firma WM Onlinemarketing und Agentur f\u00fcr digitales Marketing Walther Maar<br><br>\n2.\tTerminbest\u00e4tigung \u2013 f\u00fcr die bei Ihnen geplante Beratung und\/oder Behandlung stellen wir f\u00fcr sie besondere zeitliche, personelle sowie apparative Ressourcen bereit. Aus diesem Grunde best\u00e4tigen wir Ihnen den bevorstehenden Termin per SMS, E-Mail oder telefonisch einige Tage im Voraus.  Im Rahmen unseres Recallprogramms erinnern wir Sie m\u00f6glicherweise an notwendige Behandlungsschritte sowie Termine zur Nachkontrolle per SMS, E-Mail oder auf dem Postweg.<br><br>\n3.\tunterschiedliche Abrechnungsstellen (Privat\u00e4rztliche Verrechnungsstelle, Kassen\u00e4rztliche Vereinigung, gesetzliche Krankenkassen, private Versicherungstr\u00e4ger, Unfallkassen, Beihilfestellen, Folgekostenversicherungen) ausschlie\u00dflich zur Beantragung und\/oder Abrechnung erfolgt. Im Einzelfall kann die \u00dcbermittlung von Daten an weitere berechtigte Empf\u00e4nger notwendig sein<br><br>\n4.\tFerner bin ich damit einverstanden, dass die Privatpraxis Dr. Michaela Montanari die Dienste der Firma Jasper + Driwa GmbH, Im Pinntal 60, 46244 Bottrop und der Firma CGM Deutschland AG sowie CGM one DokuAssistenten - GB Telemed Maria Trost 21, 56070 Koblenz und Takuta GmbH, Rellinghauser Strasse 111, 45128 Essen zum Zwecke der Terminvergabe und Erinnerung verwenden darf.<br><br>\n5.\tim Falle einer notwendigen Narkose an das zust\u00e4ndige An\u00e4sthesieteam<br><br>\n6.\tExterne Untersuchungen sind in speziellen Behandlungsf\u00e4llen zur Erg\u00e4nzung der Befunde oder Planung der weiteren Therapie durch weitere Untersuchungen durch Dritte notwendig. Hierzu z\u00e4hlen zum Beispiel Labor- und pathologische Untersuchungen, die unter anderem durch die Laborgemeinschaften Springorum und IML Gatermann, dem Pathologischen Institut Ruhruniversit\u00e4t Bochum BG-Universit\u00e4tsklinikum Bergmannsheil, B\u00fcrkle-de-la-Camp-Platz 1, 44789 Bochum durchgef\u00fchrt werden. Bei Ultraschalluntersuchungen erfolgt eine Speicherung der Bilddateien auf der Cloud.clarius.com. Im Einzelfall kann die \u00dcbermittlung von Daten an weitere berechtigte Empf\u00e4nger notwendig sein.<br><br>\n7.\tan den weiterbehandelnden Arzt (falls notwendig)<br><br>\n8.\tdas Brustimplantatregister und Dienstleister f\u00fcr die Eintragung in das Brustimplantatregister<br><br>\n9.\tImplantatherstellerfirmen (z.B. der Firma Polytech Health & \u00c4sthetic GmbH, Altheimer Str. 32, 64807 Dieburg) f\u00fcr spezielle Garantieleistungen\n<br><br>\nMir ist bekannt, dass ich diese Einwilligung gegen\u00fcber der \u00c4rztin nur mit Wirkung f\u00fcr die Zukunft jederzeit formlos widerrufen kann; bisher durchgef\u00fchrte, von dieser Einwilligung abgedeckte Datenweitergaben bleiben dadurch rechtm\u00e4\u00dfig.<br><br>\nGleichzeitig entbinde ich in demselben Umfang die genannten \u00c4rztinnen und \u00c4rzte bzw. die bei den genannten Einrichtungen besch\u00e4ftigten \u00c4rztinnen und \u00c4rzte sowie das f\u00fcr die jeweilige Verarbeitung eingesetzte Personal von der Schweigepflicht.<br><br>\nMit meiner Unterschrift best\u00e4tige ich, dass ich ausreichend \u00fcber die jeweils beabsichtigten Verarbeitungen meiner pers\u00f6nlichen Daten informiert bin und freiwillig mein Einverst\u00e4ndnis in die Verarbeitung erkl\u00e4re.<br><br>\nAlle diese Daten werden von der Privatpraxis Dr. Michaela Montanari vertraulich bearbeitet, da alle Mitarbeiter der Schweigepflicht nach \u00a7203 StGB und den Bestimmungen des Datenschutzes unterliegen.\nDie schnelle elektronische Kommunikation per WhatsApp, Facebook-Messenger, SMS und E-Mail ist bereits fester Bestandteil des Privatlebens vieler Menschen. Auch Patienten legen zunehmend gr\u00f6\u00dferen Wert auf eine schnelle und vor allem elektronische Kommunikation mit ihrem Arzt. Insbesondere nach chirurgischen Eingriffen. Da hier die M\u00f6glichkeit einer schnellen und unkomplizierten Kommunikation stattfinden kann. <br><br>\nAuf besonderen Wunsch k\u00f6nnen Sie uns \u00fcber Soziale Medien, wie SMS, WhatsApp und Facebook-Messenger oder Email erreichen. Bei dieser Kommunikation handelt es sich technisch betrachtet nicht um eine sichere End-to-End-verschl\u00fcsselte Form der Kommunikation. Die Informationen sind daher weniger sicher, als in einem pers\u00f6nlichen Gespr\u00e4ch, verschl\u00fcsselten E-Mail-Kontakt oder verschlossenem Brief. <br><br>\nFrau Dr. Michaela Montanari weist sie ausdr\u00fccklich darauf hin, dass die Informationen auch von Dritten gelesen, weiterverwendet oder in sonstiger Weise genutzt werden k\u00f6nnen und sie als \u00c4rztin hierf\u00fcr keinerlei Verantwortung und Haftung \u00fcbernimmt.<br><br>\nHiermit willige ich auf eigenem Wunsch einem Kommunikationsaustausch \u00fcber ein soziales Medium und\/oder per E-Mail ein.<\/label>\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-field_b9fec32 elementor-col-100 recaptcha_v3-inline\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-field_b9fec32\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LeTCrwpAAAAAOZMbL0WF_69I8dUR5mTnEAGVxIG\" data-type=\"v3\" data-action=\"Form\" data-badge=\"inline\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-angle-double-right\" viewBox=\"0 0 448 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M224.3 273l-136 136c-9.4 9.4-24.6 9.4-33.9 0l-22.6-22.6c-9.4-9.4-9.4-24.6 0-33.9l96.4-96.4-96.4-96.4c-9.4-9.4-9.4-24.6 0-33.9L54.3 103c9.4-9.4 24.6-9.4 33.9 0l136 136c9.5 9.4 9.5 24.6.1 34zm192-34l-136-136c-9.4-9.4-24.6-9.4-33.9 0l-22.6 22.6c-9.4 9.4-9.4 24.6 0 33.9l96.4 96.4-96.4 96.4c-9.4 9.4-9.4 24.6 0 33.9l22.6 22.6c9.4 9.4 24.6 9.4 33.9 0l136-136c9.4-9.2 9.4-24.4 0-33.8z\"><\/path><\/svg>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Nachricht absenden<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Online Medical History \u2013 Dr Montanari\u2019s Private Practice Dear Patient, Welcome to Dr Michaela Montanari\u2019s private practice for plastic and cosmetic surgery. To ensure we can provide you with the best possible care, we ask that you carefully complete the following questions and details before your first appointment. * = Required field<\/p>","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-15254","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/dr-montanari.de\/en\/wp-json\/wp\/v2\/pages\/15254","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dr-montanari.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dr-montanari.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dr-montanari.de\/en\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/dr-montanari.de\/en\/wp-json\/wp\/v2\/comments?post=15254"}],"version-history":[{"count":211,"href":"https:\/\/dr-montanari.de\/en\/wp-json\/wp\/v2\/pages\/15254\/revisions"}],"predecessor-version":[{"id":15478,"href":"https:\/\/dr-montanari.de\/en\/wp-json\/wp\/v2\/pages\/15254\/revisions\/15478"}],"wp:attachment":[{"href":"https:\/\/dr-montanari.de\/en\/wp-json\/wp\/v2\/media?parent=15254"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}