{"id":102,"date":"2026-05-17T20:02:37","date_gmt":"2026-05-17T20:02:37","guid":{"rendered":"https:\/\/jebu-zorg.nl\/index.php\/intake\/"},"modified":"2026-05-24T21:02:41","modified_gmt":"2026-05-24T21:02:41","slug":"intake","status":"publish","type":"page","link":"https:\/\/jebu-zorg.nl\/index.php\/intake\/","title":{"rendered":"Intake"},"content":{"rendered":"<p class=\"wp-block-paragraph\">Gebruik dit formulier voor een eerste contactmoment. De ingevulde informatie wordt verstuurd naar Jebu Zorg.<\/p>\t<div id=\"intake-form\" class=\"intake-form-wrap\">\n\t\t\n\t\t\n\t\t<form class=\"intake-form\" method=\"post\" action=\"https:\/\/jebu-zorg.nl\/index.php\/intake\/#intake-form\">\n\t\t\t<input type=\"hidden\" id=\"jebu_intake_nonce\" name=\"jebu_intake_nonce\" value=\"59112652db\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/102\" \/>\t\t\t<input type=\"hidden\" name=\"jebu_intake_form\" value=\"1\">\n\t\t\t<p class=\"form-field form-field--hidden\">\n\t\t\t\t<label for=\"jebu_website\">Website<\/label>\n\t\t\t\t<input id=\"jebu_website\" type=\"text\" name=\"jebu_website\" value=\"\" tabindex=\"-1\" autocomplete=\"off\">\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field\">\n\t\t\t\t<label for=\"jebu_name\">Naam *<\/label>\n\t\t\t\t<input id=\"jebu_name\" type=\"text\" name=\"jebu_name\" value=\"\" required>\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field\">\n\t\t\t\t<label for=\"jebu_email\">E-mailadres *<\/label>\n\t\t\t\t<input id=\"jebu_email\" type=\"email\" name=\"jebu_email\" value=\"\" required>\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field\">\n\t\t\t\t<label for=\"jebu_phone\">Telefoonnummer<\/label>\n\t\t\t\t<input id=\"jebu_phone\" type=\"tel\" name=\"jebu_phone\" value=\"\">\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field\">\n\t\t\t\t<label for=\"jebu_birthdate\">Geboortedatum of leeftijd<\/label>\n\t\t\t\t<input id=\"jebu_birthdate\" type=\"text\" name=\"jebu_birthdate\" value=\"\">\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field\">\n\t\t\t\t<label for=\"jebu_contact_preference\">Voorkeur contact<\/label>\n\t\t\t\t<select id=\"jebu_contact_preference\" name=\"jebu_contact_preference\">\n\t\t\t\t\t<option value=\"\" selected='selected'>Maak een keuze<\/option><option value=\"E-mail\">E-mail<\/option><option value=\"Telefoon\">Telefoon<\/option><option value=\"Geen voorkeur\">Geen voorkeur<\/option>\t\t\t\t<\/select>\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field\">\n\t\t\t\t<label for=\"jebu_referral\">Verwijzing of vergoeding<\/label>\n\t\t\t\t<input id=\"jebu_referral\" type=\"text\" name=\"jebu_referral\" value=\"\">\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field form-field--wide\">\n\t\t\t\t<label for=\"jebu_message\">Hulpvraag *<\/label>\n\t\t\t\t<textarea id=\"jebu_message\" name=\"jebu_message\" rows=\"6\" required><\/textarea>\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field form-field--wide form-check\">\n\t\t\t\t<label>\n\t\t\t\t\t<input type=\"checkbox\" name=\"jebu_privacy\" value=\"1\"  required>\n\t\t\t\t\tIk geef akkoord dat deze gegevens per e-mail naar Jebu Zorg worden verstuurd.\n\t\t\t\t<\/label>\n\t\t\t<\/p>\n\n\t\t\t<p class=\"form-field form-field--wide\">\n\t\t\t\t<button class=\"button\" type=\"submit\">Intake versturen<\/button>\n\t\t\t<\/p>\n\t\t<\/form>\n\t<\/div>\n\t\n","protected":false},"excerpt":{"rendered":"<p>Vul het intakeformulier in, dan neemt Jebu Zorg contact met je op.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":50,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_jebu_page_eyebrow":"JeBu Zorg","_jebu_page_hero_text":"Vul het intakeformulier in, dan neemt Jebu Zorg contact met je op.","_jebu_page_hero_color":"","footnotes":""},"class_list":["post-102","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/jebu-zorg.nl\/index.php\/wp-json\/wp\/v2\/pages\/102","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jebu-zorg.nl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/jebu-zorg.nl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/jebu-zorg.nl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jebu-zorg.nl\/index.php\/wp-json\/wp\/v2\/comments?post=102"}],"version-history":[{"count":1,"href":"https:\/\/jebu-zorg.nl\/index.php\/wp-json\/wp\/v2\/pages\/102\/revisions"}],"predecessor-version":[{"id":106,"href":"https:\/\/jebu-zorg.nl\/index.php\/wp-json\/wp\/v2\/pages\/102\/revisions\/106"}],"wp:attachment":[{"href":"https:\/\/jebu-zorg.nl\/index.php\/wp-json\/wp\/v2\/media?parent=102"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}