{"id":1430,"date":"2025-12-05T12:05:49","date_gmt":"2025-12-05T11:05:49","guid":{"rendered":"https:\/\/www.radiologie-dr-jung.de\/?page_id=1430"},"modified":"2026-01-18T15:54:48","modified_gmt":"2026-01-18T14:54:48","slug":"order-form","status":"publish","type":"page","link":"https:\/\/www.radiologie-dr-jung.de\/en\/bestellformular\/","title":{"rendered":"Order form"},"content":{"rendered":"<section class=\"l-section wpb_row us_custom_887a049b height_small\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row via_grid cols_1 laptops-cols_inherit tablets-cols_inherit mobiles-cols_1 valign_top type_default stacking_default\"><div class=\"wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"w-separator size_large\"><\/div><div class=\"wpb_text_column us_custom_59ffc91f us_animate_this\"><div class=\"wpb_wrapper\"><h1>Order form<\/h1>\n<h6>Order advertising material for your practice now<\/h6>\n<p>On this page you have the opportunity to conveniently order various printed materials that you can pass on to your patients in your practice.<\/p>\n<\/div><\/div><div class=\"w-separator size_medium\"><\/div><div class=\"w-separator size_custom\" style=\"height:2rem\" id=\"v316\"><style><\/style><\/div><div class=\"w-separator us_custom_11d22d30 us_animate_this size_custom\" style=\"height:400px\"><\/div>\n<div class=\"wpcf7 no-js us_custom_55ae7626 us_animate_this\" id=\"wpcf7-f1429-o1\" lang=\"de-DE\" dir=\"ltr\" data-wpcf7-id=\"1429\">\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\/1430#wpcf7-f1429-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\" data-trp-original-action=\"\/en\/wp-json\/wp\/v2\/pages\/1430#wpcf7-f1429-o1\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"1429\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.6\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"de_DE\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f1429-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div id=\"responsive-form\" class=\"clearfix\">\n\t<div class=\"form-row\">\n\t\t<div class=\"column-half\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-praxis\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Practice name\" value=\"\" type=\"text\" name=\"your-praxis\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Title, first name, surname\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-half\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-strasse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Street, house number\" value=\"\" type=\"text\" name=\"your-strasse\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-ort\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Postcode, city\" value=\"\" type=\"text\" name=\"your-ort\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p>As a referrer, I would like to order the following printed material to pass on to patients: <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-644\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-644[]\" value=\"Visitenkarten\" \/><span class=\"wpcf7-list-item-label\">Business cards<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-644[]\" value=\"Flyer\" \/><span class=\"wpcf7-list-item-label\">Flyer<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p><label style=\"font-size:15px;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-363\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"acceptance-363\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I consent to my data being processed and stored for the purpose of contacting me. The <a href=\"\/en\/data-protection\/\"><b>Data protection notice<\/b><\/a> I was able to take note of this. Consent can be revoked at any time with effect for the future. To do so, please simply send a short e-mail to <b><a href=\"mailto:info@radiologie-dr-jung.de\">info@radiologie-dr-jung.de<\/a><\/b> send. Please read the <a href=\"\/en\/data-protection\/\"><b>Data protection notice<\/b><\/a> for further information.<\/span><\/label><\/span><\/span><\/span><br \/>\n<input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Sending\" \/><br \/>\n<\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<input type=\"hidden\" name=\"trp-form-language\" value=\"en\"\/><\/form>\n<\/div>\n<div class=\"w-separator size_custom\" style=\"height:0\" id=\"x687\"><style>@media(max-width:1024px){ #x687{height:2rem!important}}@media(max-width:600px){ #x687{height:2rem!important}}<\/style><\/div><\/div><\/div><\/div><\/div><\/section>","protected":false},"excerpt":{"rendered":"Bestellformular Jetzt Werbematerial f\u00fcr Ihre Praxis bestellen Auf dieser Seite haben Sie die M\u00f6glichkeit, bequem verschiedene Drucksachen zu bestellen, die Sie in Ihrer Praxis an Ihre Patientinnen und Patienten weitergeben k\u00f6nnen. Als \u00dcberweiser\/in m\u00f6chte ich gerne folgende Drucksachen zur Weitergabe an Patienten\/innen bestellen: VisitenkartenFlyer Ich willige ein, dass meine Daten zur Kontaktaufnahme verarbeitet und gespeichert...","protected":false},"author":2,"featured_media":17,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1430","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Bestellformular \u1405 Radiologische Privatpraxis Dr. Catarina Jung<\/title>\n<meta name=\"description\" content=\"Bestellformular \u2713 Auf dieser Seite k\u00f6nnen Sie ganz einfach verschiedene Drucksachen zur Weitergabe in Ihrer Praxis bestellen.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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