{"id":853,"date":"2023-06-21T13:14:03","date_gmt":"2023-06-21T11:14:03","guid":{"rendered":"https:\/\/tandartsjanvangalen.nl\/nieuwe-patient\/"},"modified":"2025-10-15T10:41:48","modified_gmt":"2025-10-15T08:41:48","slug":"new-client","status":"publish","type":"page","link":"https:\/\/tandartsjanvangalen.nl\/en\/new-client\/","title":{"rendered":"New client"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row css=&#8221;.vc_custom_1688045305388{padding-top: 50px !important;padding-bottom: 100px !important;}&#8221;][vc_column offset=&#8221;vc_col-lg-6 vc_col-md-6&#8243; el_id=&#8221;buttons-column&#8221;][vc_column_text]<\/p>\n<p class=\"sub-heading\">Tandarts Jan van Galen<\/p>\n<h2 class=\"entry-title\">New patient<\/h2>\n<p>[\/vc_column_text][vc_column_text]At the moment it is possible to register at our practice. Simply fill in the form.\u00a0at the bottom of this page. Of course, you may also phone or pay us a visit in person.[\/vc_column_text][vc_column_text]<\/p>\n<blockquote><p>I encountered waiting lists at many dentists in Amsterdam. Fortunately, I was able to get an appointment with the dentist right away at Tandartspraktijk Jan van Galen for the cavity in my tooth.<\/p><\/blockquote>\n<p>[\/vc_column_text]<a  href=\"tel:0031206180074\"  target=\"_self\"  title=\"\" class=\"tt_button tt_primary_button btn_primary_color  pull-left button-action-link\" ><span class=\"prim_text\">Give us a call<\/span><\/a><a  href=\"https:\/\/tandartsjanvangalen.nl\/en\/contact\/\"  target=\"_self\"  title=\"Contact\" class=\"tt_button tt_secondary_button btn_secondary_color  pull-left button-action-link\" ><span class=\"prim_text\">Contact us<\/span><\/a>[vc_empty_space height=&#8221;5px&#8221;][vc_column_text]<\/p>\n<header class=\"kd-section-title col-lg-12 text-left titel-blok-h3-font \">\n<p class=\"separator_off\"><strong><br \/>\nTHE FIRST APPOINTMENT<\/strong><br \/>\nAt the first appointment lasting 40 minutes you will meet your dentist. The dentist will examine your mouth and if necessary take X-rays. Your wishes and dental history will also be discussed in depth during the initial appointment. If you bring digital X-rays taken less than 18 months before, the dentist can assess them and, in some cases, decide not to take any more. Prior to your visit we ask you to complete a medical questionnaire.<\/p>\n<p>Depending on the health of your teeth and your personal preferences, the dentist will create a customized treatment plan. This plan could involve regular in-practice visits for periodic check-ups and regular appointments with the dental hygienist. However, aesthetic treatments such as placing veneers or dentures are also possible.<\/p>\n<\/header>\n<div class=\"wpb_text_column wpb_content_element \">\n<div class=\"wpb_wrapper\">\n<header class=\"kd-section-title col-lg-12 text-left titel-blok-h3-font \">\n<p class=\"separator_off\"><strong>PREPARATIONS FOR YOUR FIRST VISIT<br \/>\n<\/strong>We would like you to bring your previous dental records if possible as well as an ID and health insurance card.<\/p>\n<\/header>\n<\/div>\n<\/div>\n<p>[\/vc_column_text][\/vc_column][vc_column width=&#8221;2\/3&#8243; offset=&#8221;vc_col-lg-6 vc_col-md-6 vc_col-xs-12&#8243;][vc_single_image image=&#8221;1407&#8243; img_size=&#8221;full&#8221; css=&#8221;&#8221; el_class=&#8221;.padding-image-responsive-button&#8221;][\/vc_column][\/vc_row][vc_row full_width=&#8221;stretch_row&#8221; el_class=&#8221;background-row-lightMint&#8221; css=&#8221;.vc_custom_1688371711469{padding-top: 100px !important;padding-bottom: 100px !important;}&#8221;][vc_column]<header class=\"kd-section-title col-lg-12 text-center    \" ><h2 class=\"separator_off\" >NEW PATIENT REGISTRATION<\/h2><\/header><div class=\"kd-contact-form full-width-cf\" >\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f917-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"917\">\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\/853#wpcf7-f917-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=\"917\" \/><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-f917-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_group_fields\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_hidden_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_visible_groups\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_repeaters\" value=\"[]\" \/><input type=\"hidden\" name=\"_wpcf7cf_steps\" value=\"{}\" \/><input type=\"hidden\" name=\"_wpcf7cf_options\" value=\"{&quot;form_id&quot;:917,&quot;conditions&quot;:[{&quot;then_field&quot;:&quot;group-inschrijvingpartner&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-partnerook&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Ja&quot;}]},{&quot;then_field&quot;:&quot;group-inschrijvingkinderen&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-kinderenook&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Ja&quot;}]},{&quot;then_field&quot;:&quot;group-hoeveelheidkinderen&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-kinderenook&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;Ja&quot;}]},{&quot;then_field&quot;:&quot;group-kind1&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-hoeveelkinderen&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;1&quot;}]},{&quot;then_field&quot;:&quot;group-kind2&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-hoeveelkinderen&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;2&quot;}]},{&quot;then_field&quot;:&quot;group-kind3&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-hoeveelkinderen&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;3&quot;}]},{&quot;then_field&quot;:&quot;group-kind1&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-hoeveelkinderen&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;2&quot;}]},{&quot;then_field&quot;:&quot;group-kind2&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-hoeveelkinderen&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;3&quot;}]},{&quot;then_field&quot;:&quot;group-kind3&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-hoeveelkinderen&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;3&quot;}]},{&quot;then_field&quot;:&quot;group-kind1&quot;,&quot;and_rules&quot;:[{&quot;if_field&quot;:&quot;radio-hoeveelkinderen&quot;,&quot;operator&quot;:&quot;equals&quot;,&quot;if_value&quot;:&quot;3&quot;}]}],&quot;settings&quot;:{&quot;animation&quot;:&quot;yes&quot;,&quot;animation_intime&quot;:200,&quot;animation_outtime&quot;:200,&quot;conditions_ui&quot;:&quot;normal&quot;,&quot;notice_dismissed&quot;:false,&quot;repeater_remove_button&quot;:&quot;bottom&quot;,&quot;notice_dismissed_rollback-cf7-5.8.3&quot;:true}}\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"panel-group\" id=\"accordion\">\n\t<div class=\"panel panel-default\">\n\t\t<div class=\"panel-heading\">\n\t\t\t<h4 class=\"panel-title\"><a data-toggle=\"collapse\" data-parent=\"#accordion\" href=\"#collapse1\" class=\"uitgeklapt\">Registration form<\/a>\n\t\t\t<\/h4>\n\t\t<\/div>\n\t\t<div id=\"collapse1\" class=\"panel-collapse collapse in\">\n\t\t\t<div class=\"panel-body\">\n\t\t\t\t<p>Would you also like to register your partner?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-partnerook\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-partnerook\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-partnerook\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<p>Would you also like to register your children?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-kinderenook\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-kinderenook\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-kinderenook\" value=\"No\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t\t<div data-id=\"group-hoeveelheidkinderen\" data-orig_data_id=\"group-hoeveelheidkinderen\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t\t<p>How many children would you like to register?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-hoeveelkinderen\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"radio-hoeveelkinderen\" value=\"1\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">1<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"radio\" name=\"radio-hoeveelkinderen\" value=\"2\" \/><span class=\"wpcf7-list-item-label\">2<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"radio-hoeveelkinderen\" value=\"3\" \/><span class=\"wpcf7-list-item-label\">3<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t\t<p><label class=\"col-xs-12 col-sm-6\"><br \/>\nName<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"voornaam_en_achternaam\"><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=\"voornaam_en_achternaam\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nDate 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\" value=\"\" type=\"text\" name=\"geboortedatum\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nTel. mobile<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telmobiel\"><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=\"telmobiel\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nE-mail address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"e-mailadres\"><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=\"e-mailadres\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nBsn number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"bsnnummer\"><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=\"bsnnummer\" \/><\/span><br \/>\n<\/label>\n\t\t\t\t<\/p>\n\t\t\t\t<p class=\"col-xs-12 col-sm-12\"><br \/>\nGender<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"geslacht\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"geslacht\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"geslacht\" value=\"Women\" \/><span class=\"wpcf7-list-item-label\">Women<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div data-id=\"group-inschrijvingpartner\" data-orig_data_id=\"group-inschrijvingpartner\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"panel panel-default\">\n\t\t\t<div class=\"panel-heading\">\n\t\t\t\t<h4 class=\"panel-title\"><a data-toggle=\"collapse\" data-parent=\"#accordion\" href=\"#collapse2\" class=\"uitgeklapt\">Registration Partner<\/a>\n\t\t\t\t<\/h4>\n\t\t\t<\/div>\n\t\t\t<div id=\"collapse2\" class=\"panel-collapse collapse in\">\n\t\t\t\t<div class=\"panel-body\">\n\t\t\t\t\t<p><label class=\"col-xs-12 col-sm-6\"><br \/>\nName<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"voornaam_en_achternaam_partner\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"voornaam_en_achternaam_partner\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nDate of birth<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"geboortedatum_partner\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"geboortedatum_partner\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nTel. mobile<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telmobiel_partner\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"telmobiel_partner\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nE-mail address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"e-mailadres_partner\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"e-mailadres_partner\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nBsn number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"bsnnummer_partner\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"bsnnummer_partner\" \/><\/span><br \/>\n<\/label>\n\t\t\t\t\t<\/p>\n\t\t\t\t\t<p class=\"col-xs-12 col-sm-12\"><br \/>\nGender<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"geslacht_partner\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"geslacht_partner\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"geslacht_partner\" value=\"Woman\" \/><span class=\"wpcf7-list-item-label\">Woman<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div data-id=\"group-inschrijvingkinderen\" data-orig_data_id=\"group-inschrijvingkinderen\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t<div class=\"panel panel-default\">\n\t\t\t<div class=\"panel-heading\">\n\t\t\t\t<h4 class=\"panel-title\"><a data-toggle=\"collapse\" data-parent=\"#accordion\" href=\"#collapse3\" class=\"uitgeklapt\">Registration Children<\/a>\n\t\t\t\t<\/h4>\n\t\t\t<\/div>\n\t\t\t<div id=\"collapse3\" class=\"panel-collapse collapse in\">\n\t\t\t\t<div class=\"panel-body\">\n\t\t\t\t\t<div data-id=\"group-kind1\" data-orig_data_id=\"group-kind1\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t\t\t<h2 class=\"section-titles-20 margintop20\">Child 1\n\t\t\t\t\t\t<\/h2>\n\t\t\t\t\t\t<p><label class=\"col-xs-12 col-sm-6\"><br \/>\nName<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"voornaam_en_achternaam_kind1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"voornaam_en_achternaam_kind1\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nDate of birth<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"geboortedatum_kind1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"geboortedatum_kind1\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nTel. mobile<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telmobiel_kind1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"telmobiel_kind1\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nE-mail address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"e-mailadres_kind1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"e-mailadres_kind1\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nBsn number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"bsnnummer_kind1\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"bsnnummer_kind1\" \/><\/span><br \/>\n<\/label>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<p class=\"col-xs-12 col-sm-12\"><br \/>\nGender<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"use_label_element\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"use_label_element\" value=\"Man\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Man<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"use_label_element\" value=\"Vrouw\" \/><span class=\"wpcf7-list-item-label\">Vrouw<\/span><\/span><\/span><\/span>\n\t\t\t\t\t\t<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div data-id=\"group-kind2\" data-orig_data_id=\"group-kind2\"  class=\"\" data-class=\"wpcf7cf_group\">\n\t\t\t\t\t\t<h2 class=\"section-titles-20 margintop20\" style=\"padding-top:20px !important;\">Child 2\n\t\t\t\t\t\t<\/h2>\n\t\t\t\t\t\t<p><label class=\"col-xs-12 col-sm-6\"><br \/>\nName<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"voornaam_en_achternaam_kind2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"voornaam_en_achternaam_kind2\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nDate of birth<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"geboortedatum_kind2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"geboortedatum_kind2\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nTel. mobile<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"telmobiel_kind2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"telmobiel_kind2\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nE-mail address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"e-mailadres_kind2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"e-mailadres_kind2\" \/><\/span><br \/>\n<\/label><label class=\"col-xs-12 col-sm-6\"><br \/>\nBsn number<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"bsnnummer_kind2\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" 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