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zur Blutverd\u00fcnnung ein ?","options":[{"option_label":"Sind Sie zur Zeit in zahn\u00e4rztlicher Behandlung ?","option_value":"","option_selected":false,"option_assigned_groups":null},{"option_label":"Nehmen Sie regelm\u00e4ssig Medikamente ein ?","option_value":"","option_selected":false,"option_assigned_groups":null},{"option_label":"Nehmen Sie ein Medikament zur Blutverd\u00fcnnung ein ?","option_value":"","option_selected":false,"option_assigned_groups":null},{"option_label":"Besitzen Sie einen Endokartitispass ?","option_value":"","option_selected":false,"option_assigned_groups":null},{"option_label":"Waren Sie innerhalb der letzten Jahre im Spital ?","option_value":"","option_selected":false,"option_assigned_groups":null},{"option_label":"Allergien","option_value":"","option_selected":false,"option_assigned_groups":null},{"option_label":"Hepatitis (Gelbsucht) A, B oder C 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Wenn ja, welche ?","option_value":"","option_selected":false,"option_assigned_groups":null},{"option_label":"F\u00fcr Patientinnen, sind Sie schwanger ? wenn ja, in welchem Monat ?","option_value":"","option_selected":false,"option_assigned_groups":null}]},{"field_id":"f674f83b-7390-44f2-b0ad-0b9e37093ad5-field-47","field_name":"f674f83b-7390-44f2-b0ad-0b9e37093ad5-field-47","field_type":"textarea","field_label":"Schlussbest\u00e4tigung:","field_placeholder":"Ich entbinde die Zahn\u00e4rztin von der Schweigepflicht zur Geltendmachung ihrer Honorarforderungen und nehme zur Kenntnis, dass ab der 3. Mahnung eine Mahngeb\u00fchr von CHF 100 erhoben wird. 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{"no_option":"Keine Option","subscribe_to_newsletter":"Newsletter abonnieren","subscribe_to_newsletter_yes":"Ja","subscribe_to_newsletter_no":"Nein","send_form_to_me_label":"Kopie an mich senden","choose_file":"Datei ausw\u00e4hlen","invalid_email":"E-Mail ist nicht korrekt","email_does_not_match":"E-Mail stimmt nicht \u00fcberein","password_does_not_match":"Passwort stimmt nicht \u00fcberein","captcha_failed":"Captcha-Verifikation fehlgeschlagen. Bitte versuchen Sie es erneut.","field_required":"Dieses Feld ist notwendig","unknown_error":"Unbekannter Error. Bitte neu laden","on_submit_text":"Vielen Dank f\u00fcr das Einreichen des Formulars."}