{"id":2229,"date":"2019-03-26T11:26:17","date_gmt":"2019-03-26T10:26:17","guid":{"rendered":"https:\/\/www.rehan.de\/bestelformulier\/"},"modified":"2019-09-06T15:56:32","modified_gmt":"2019-09-06T13:56:32","slug":"order-form","status":"publish","type":"page","link":"https:\/\/www.rehan.de\/en\/pain-relief\/tens-consumables\/order-form\/","title":{"rendered":"Order form for TENS consumables\/accessories"},"content":{"rendered":"<section class=\"l-section wpb_row height_medium\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_top\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3156-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"3156\">\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\/2229#wpcf7-f3156-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=\"3156\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"nl_NL\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3156-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"g-cols vc_row type_default valign_top order-form-row\">\n\t<div class=\"vc_col-sm-12 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h3>Your data\n\t\t\t<\/h3>\n\t\t<\/div>\n\t<\/div>\n\t<div class = \"vc_col-sm-6 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Initials or firstname <span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Initials or firstname\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span><\/label><br \/>\n<label>Lastname* <span class=\"wpcf7-form-control-wrap\" data-name=\"lastname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Lastname\" value=\"\" type=\"text\" name=\"lastname\" \/><\/span><\/label><br \/>\n<label>Street name* <span class=\"wpcf7-form-control-wrap\" data-name=\"streetname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Street name\" value=\"\" type=\"text\" name=\"streetname\" \/><\/span><\/label><br \/>\n<label>Zip code* <span class=\"wpcf7-form-control-wrap\" data-name=\"postalcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Zip code\" value=\"\" type=\"text\" name=\"postalcode\" \/><\/span><\/label><br \/>\n<label>Phone number* <span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"hone number.\" value=\"\" type=\"tel\" name=\"tel\" \/><\/span><\/label><br \/>\n<label>Date of birth* <span class=\"wpcf7-form-control-wrap\" data-name=\"dob\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Date of birth\" value=\"\" type=\"text\" name=\"dob\" \/><\/span><\/label><br \/>\n<label>Health insurer* <span class=\"wpcf7-form-control-wrap\" data-name=\"insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Health insurer\" value=\"\" type=\"text\" name=\"insurance\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p>Required fields are marked with an *\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-6 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Suffix <span class=\"wpcf7-form-control-wrap\" data-name=\"suffix\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Suffix\" value=\"\" type=\"text\" name=\"suffix\" \/><\/span><\/label><br \/>\n<label>Company name <span class=\"wpcf7-form-control-wrap\" data-name=\"company\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Company name\" value=\"\" type=\"text\" name=\"company\" \/><\/span><\/label><br \/>\n<label>House number* <span class=\"wpcf7-form-control-wrap\" data-name=\"housenumber\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"House number\" value=\"\" type=\"text\" name=\"housenumber\" \/><\/span><\/label><br \/>\n<label>City* <span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"City\" value=\"\" type=\"text\" name=\"city\" \/><\/span><\/label><br \/>\n<label>Emailaddress* <span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Emailaddress\" value=\"\" type=\"email\" name=\"email\" \/><\/span><\/label><br \/>\n<label>Social security number <span class=\"wpcf7-form-control-wrap\" data-name=\"bsn\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" placeholder=\"Social security number\" value=\"\" type=\"number\" name=\"bsn\" \/><\/span><\/label><br \/>\n<label>Insurance number <span class=\"wpcf7-form-control-wrap\" data-name=\"polis\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" aria-invalid=\"false\" placeholder=\"Policy number\" value=\"\" type=\"number\" name=\"polis\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"g-cols vc_row type_default valign_top order-form-row\">\n\t<div class = \"vc_col-sm-12 wpb_column email-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h3>Your device\n\t\t\t<\/h3>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-6 wpb_column select-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Device <span class=\"wpcf7-form-control-wrap\" data-name=\"device\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"device\"><option value=\"\">&#8212;Kies een optie&#8212;<\/option><option value=\"i-Pulz\">i-Pulz<\/option><option value=\"TwinStar\">TwinStar<\/option><option value=\"Twin+\">Twin+<\/option><option value=\"Twin***\">Twin***<\/option><option value=\"Other\">Other<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-6 wpb_column select-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Other <span class=\"wpcf7-form-control-wrap\" data-name=\"rem-device\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Type of device\" value=\"\" type=\"text\" name=\"rem-device\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"g-cols vc_row type_default valign_top order-form-row\">\n\t<div class = \"vc_col-sm-12 wpb_column product-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h3>Indicate which accessories you want to order\n\t\t\t<\/h3>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Black silicone electrodes<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"SQ05\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"SQ05\" \/><\/span><label>SQ05 black electrodes 38x44.5 mm (per 4 pieces)<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Bandages<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"AH08\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"AH08\" \/><\/span><label>AH08, keyhole plaster (per 100 packed)<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"AH10\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"AH10\" \/><\/span><label>AH10 Mefix Plaster roll 10 cm x 10 meter, adhesive plaster<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Gels<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"GEL01\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"GEL01\" \/><\/span><label>GEL01, Conductive gel 60 gram<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"GEL02\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"GEL02\" \/><\/span><label>GEL02, Tac adhesive gel 50 gr<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"GEL03\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"GEL03\" \/><\/span><label>GEL03, Pre-tac adhesive fluid 15 ml<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"SKIN\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"SKIN\" \/><\/span><label>SKIN, tens clean cote (per 50 pieces)<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Adhesive electrodes<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE01\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE01\" \/><\/span><label>DE01, 4x4 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE02\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE02\" \/><\/span><label>DE02, 4x8cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE04\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE04\" \/><\/span><label>DE04, 3,2cm round<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE11\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE11\" \/><\/span><label>DE11, 5cm round<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE13\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE13\" \/><\/span><label>DE13, 3,8x5cm oval<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE16\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE16\" \/><\/span><label>DE16, 4,5x9,5cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE19\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE19\" \/><\/span><label>DE19, 4,5x4,5 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE20\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE20\" \/><\/span><label>DE20, 4,5x4,5cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE24\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE24\" \/><\/span><label>DE24, 5x5cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE25\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE25\" \/><\/span><label>DE25, 15x9,5cm a piece<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE29\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE29\" \/><\/span><label>DE29, 4x35cm a piece<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE41\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE41\" \/><\/span><label>DE41, 4x4cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE42\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE42\" \/><\/span><label>DE42, 4x4cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE43\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE43\" \/><\/span><label>DE43, 3,8x5 cm oval<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE45\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE45\" \/><\/span><label>DE45, 15x9,5cm a piece<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE46\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE46\" \/><\/span><label>DE46, 4x4 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE47\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"10\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE47\" \/><\/span><label>DE47, 5,1x5,1cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<p>For multiple use, per package of 4 pieces unless stated otherwise\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>TENS-wires <\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz50cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz50cm\" \/><\/span><label>Wire i-Pulz 50 cm \u2022<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz120cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz120cm\" \/><\/span><label>Wire i-Pulz 120 cm \u2022<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz150cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz150cm\" \/><\/span><label>Wire i-Pulz 150 cm \u2022<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Splitter\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Splitter\" \/><\/span><label>Splitter-Wire for i-Pulz (per 4 packed)<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<p>\u2022 Packed per 2 pieces\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"g-cols vc_row type_default valign_top order-form-row\">\n\t<div class = \"vc_col-sm-12 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h3>Further remarks\n\t\t\t<\/h3>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Remark <span class=\"wpcf7-form-control-wrap\" data-name=\"comments\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"comments\"><\/textarea><\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"privacy-statement\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"privacy-statement\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I agree with the privacy statement and the terms and conditions.<\/span><\/label><\/span><\/span><\/span><br \/>\n<button class=\"btn-purple btn-solid btn-200\" id=\"send-form\" type=\"submit\"> Order<\/button>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div><\/section>\n","protected":false},"excerpt":{"rendered":"Your data Initials or firstname Lastname* Street name* Zip code* Phone number* Date of birth* Health insurer* Required fields are marked with an * Suffix Company name House number* City* Emailaddress* Social security number Insurance number Your device Device &#8212;Kies een optie&#8212;i-PulzTwinStarTwin+Twin***Other Other Indicate which accessories you want to order Black silicone electrodes SQ05 black...","protected":false},"author":1,"featured_media":0,"parent":2230,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"inline_featured_image":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"class_list":["post-2229","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Order form for TENS consumables\/accessories - Rehan Medizinger\u00e4te Handels 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