{"id":1208,"date":"2018-06-18T12:20:09","date_gmt":"2018-06-18T10:20:09","guid":{"rendered":"https:\/\/www.mmc.nl\/chirurgie\/?page_id=1208"},"modified":"2024-02-15T16:43:54","modified_gmt":"2024-02-15T15:43:54","slug":"contactformulier","status":"publish","type":"page","link":"https:\/\/www.mmc.nl\/chirurgie\/contactformulier\/","title":{"rendered":"Contactformulier"},"content":{"rendered":"<p>Bent u al pati\u00ebnt bij M\u00e1xima MC? MijnMMC is d\u00e9 digitale omgeving voor u als pati\u00ebnt. Via uw computer, tablet of smartphone heeft u altijd uw medische gegevens bij de hand en kunt u zelf veilig en gemakkelijk uw ziekenhuiszaken regelen. Waar en wanneer het u uitkomt.<\/p>\n<p><a class=\"button-primary\" href=\"http:\/\/mijn.mmc.nl\/\" target=\"_blank\" rel=\"noopener\">Ga naar MijnMMC<\/a><\/p>\n<p><strong>Contactformulier<\/strong><br \/>\nBent u (nog) geen pati\u00ebnt in M\u00e1xima MC en heeft u een algemene (niet-medische) vraag? Maak dan gebruik van onderstaand contactformulier.<\/p>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 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action='\/chirurgie\/wp-json\/wp\/v2\/pages\/1208#gf_4' data-formid='4' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_page_4_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><ul id='gform_fields_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_4_2\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_2\" ><label class='gfield_label gform-field-label' for='input_4_2'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_2' id='input_4_2' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_4\" 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name='input_5' id='input_4_5' type='tel' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_4_6\" class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_6\" ><label class='gfield_label gform-field-label' for='input_4_6'>Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_6' id='input_4_6' type='text' value='' class='datepicker gform-datepicker dmy_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='dd-mm-yyyy' aria-describedby=\"input_4_6_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_6_date_format' class='screen-reader-text'>DD dash MM dash JJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_6' class='gform_hidden' value='https:\/\/www.mmc.nl\/chirurgie\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_4_7\" class=\"gfield gfield--type-textarea gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_7\" ><label class='gfield_label gform-field-label' for='input_4_7'>Bericht<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_7' id='input_4_7' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_4_8\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_8\" ><p><span style=\"font-size:10px\"><span style=\"font-family:Arial,Helvetica,sans-serif\">Wij vragen u om uw contactgegevens en uw geboortedatum zodat wij gericht uw vraag kunnen beantwoorden.Bekijk ook onze <a href=\"https:\/\/www.mmc.nl\/privacy\" target=\"_blank\">privacystatement<\/a>.<\/span><\/span><\/p>\n<\/li><\/ul>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_4_9' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Controleer en verstuur'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_2' class='gform_page gform_review_page ' data-js='page-field-id-9' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <ul id='gform_fields_4_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_4_10\" class=\"gfield gfield--type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_10\" ><table width=\"99%\" border=\"0\" cellpadding=\"1\" cellspacing=\"0\" bgcolor=\"#EAEAEA\"><tr><td>\r\n                            <table width=\"100%\" border=\"0\" cellpadding=\"5\" cellspacing=\"0\" bgcolor=\"#FFFFFF\">\r\n                            <\/table>\r\n                        <\/td>\r\n                   <\/tr>\r\n               <\/table><\/li><li id=\"field_4_20250521\" class=\"gfield gfield--type-captcha field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_20250521\" ><label class='gfield_label gform-field-label' for='input_4_20250521'>Typ hier de code<\/label><div class='gfield_captcha_container'><img class='gfield_captcha lazyload' data-src='https:\/\/www.mmc.nl\/chirurgie\/wp-content\/uploads\/sites\/5\/gravity_forms\/0-41f973712465b3c9903fea3db53b4076\/1930847692.png' alt='' width='150' height='42' src='data:image\/gif;base64,R0lGODlhAQABAAAAACH5BAEKAAEALAAAAAABAAEAAAICTAEAOw==' style='--smush-placeholder-width: 150px; --smush-placeholder-aspect-ratio: 150\/42;' \/><div class='gfield_captcha_input_container simple_captcha_medium'><input type='text' autocomplete='off' name='input_20250521' id='input_4_20250521' \/><input type='hidden' name='input_captcha_prefix_20250521' value='1930847692' \/><\/div><\/div><\/li><li id=\"field_4_20250522\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_4_20250522\" ><label class='gfield_label gform-field-label' for='input_4_20250522'>Email<\/label><div class='ginput_container'><input name='input_20250522' id='input_4_20250522' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_4_20250522'>Dit veld is bedoeld voor validatiedoeleinden en moet niet worden gewijzigd.<\/div><\/li><\/ul><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_4' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Ga terug'  \/> <input type='submit' id='gform_submit_button_4' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Versturen'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_4' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_4' id='gform_theme_4' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_4' id='gform_style_settings_4' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_4' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='4' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_4' value='WyJbXSIsImY0MjNjOTJhMzk3MTZiYjU5NDg1OWU0NjVmZGI1YWY4Il0=' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_4' 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MijnMMC is d\u00e9 digitale omgeving voor u als pati\u00ebnt. Via uw computer, tablet of smartphone heeft u altijd uw medische gegevens bij de hand en kunt u zelf veilig en gemakkelijk uw ziekenhuiszaken regelen. Waar en wanneer het u uitkomt. Ga naar MijnMMC Contactformulier Bent u (nog) geen [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":1,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"ep_exclude_from_search":false,"footnotes":""},"tags":[949,950],"class_list":["post-1208","page","type-page","status-publish","has-post-thumbnail","hentry","tag-contactformulier","tag-e-mail"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v24.9 (Yoast SEO v24.9) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Contactformulier - Chirurgie - M\u00e1xima MC<\/title>\n<meta name=\"description\" content=\"Neem contact op met afdeling chirurgie van M\u00e1xima MC met het contactformulier. 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