{"id":8503,"date":"2025-10-12T17:42:01","date_gmt":"2025-10-12T15:42:01","guid":{"rendered":"https:\/\/clinicabenissa.com\/?page_id=8503"},"modified":"2025-10-12T18:35:29","modified_gmt":"2025-10-12T16:35:29","slug":"registratiewijziging","status":"publish","type":"page","link":"https:\/\/clinicabenissa.com\/nl\/registratiewijziging\/","title":{"rendered":"Gegevens registreren of wijzigen"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"8503\" class=\"elementor elementor-8503\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-1de0ccf e-flex e-con-boxed e-con e-parent\" data-id=\"1de0ccf\" data-element_type=\"container\" data-e-type=\"container\" id=\"titulo-principal\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b3bea0f elementor-widget elementor-widget-heading\" data-id=\"b3bea0f\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Gegevens registreren of wijzigen<\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-d111185 espsup espinf e-flex e-con-boxed e-con e-parent\" data-id=\"d111185\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ce6183d elementor-widget elementor-widget-text-editor\" data-id=\"ce6183d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Gebruik het onderstaande formulier om u aan te melden als pati\u00ebnt of om uw gegevens te wijzigen.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fea8839 elementor-widget elementor-widget-shortcode\" data-id=\"fea8839\" data-element_type=\"widget\" data-e-type=\"widget\" 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#112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_2' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2'  action='\/nl\/wp-json\/wp\/v2\/pages\/8503#gf_2' data-formid='2' novalidate data-trp-original-action=\"\/nl\/wp-json\/wp\/v2\/pages\/8503#gf_2\">\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Stap <span class='gf_step_current_page'>1<\/span> van <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_25' style='width:25%;'><span>25%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_29\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_29'>Naam<\/label><div class='ginput_container'><input name='input_29' id='input_2_29' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_2_29'>Dit veld is voor validatiedoeleinden en moet ongewijzigd blijven.<\/div><\/div><div id=\"field_2_13\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Persoonlijke informatie<\/h3><\/div><div id=\"field_2_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_1'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_2_1' type='text' value='' class='large'    placeholder='Naam * Naam * Naam * Naam * Naam * Naam * Naam * Naam * Naam * Naam * Naam * Naam * Naam * Naam' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_28'>Achternaam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_2_28' type='text' value='' class='large'    placeholder='Achternaam* Achternaam* Achternaam* Achternaam* Achternaam* Achternaam* Achternaam' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_3\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_3'>E-mail<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_3' id='input_2_3' type='email' value='' class='large'   placeholder='E-mail * E-mail' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_2_4\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_4'>Telefoon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_2_4' type='text' value='' class='large'    placeholder='Telefoon' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_9'>Geboortedatum* Geboortedatum<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_9' id='input_2_9' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='Geboortedatum' aria-describedby=\"input_2_9_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_2_9_date_format' class='screen-reader-text'>DD schuine streep MM schuine streep JJJJJ<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_2_9' class='gform_hidden' value='https:\/\/clinicabenissa.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_2_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_11'>Nationaliteit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_2_11' type='text' value='' class='large'    placeholder='Nationaliteit * Nationaliteit * Nationaliteit * Nationaliteit * Nationaliteit * Nationaliteit * Nationaliteit * Nationaliteit * Nationaliteit * Nationaliteit' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_12'>Ziektekostenverzekering<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_2_12' type='text' value='' class='large'    placeholder='Ziektekostenverzekering * Ziektekostenverzekering * Ziektekostenverzekering * Ziektekostenverzekering * Ziektekostenverzekering * Ziektekostenverzekering * Ziektekostenverzekering' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_10'>Polisnummer<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_2_10' type='text' value='' class='large'    placeholder='Polisnummer* Polisnummer* Polisnummer' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_2_25' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-25' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_24\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Adres in Spanje<\/h3><\/div><div id=\"field_2_18\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_18'>Straat<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_18' id='input_2_18' type='text' value='' class='large'    placeholder='Straat' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_17'>Adres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_2_17' type='text' value='' class='large'    placeholder='Aantal * Aantal * Aantal * Aantal * Aantal * Aantal * Aantal * Aantal * Aantal * Aantal * Aantal * Aantal * Aantal *' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_15'>Postcode<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_2_15' type='text' value='' class='large'    placeholder='Postcode* Postcode* Postcode* Postcode' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_2_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_16'>Locatie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_2_16' type='text' value='' class='large'    placeholder='Locatie' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_26' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Vorige'  \/> <input type='button' id='gform_next_button_2_26' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-26' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_19\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Medische geschiedenis<\/h3><\/div><div id=\"field_2_21\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_21'>Ziekten<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_2_21' class='textarea large'  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ginput_container_textarea'><textarea name='input_23' id='input_2_23' class='textarea large'    placeholder='Medicatie'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_2_27' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Vorige'  \/> <input type='button' id='gform_next_button_2_27' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Volgende'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' data-js='page-field-id-27' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_20\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Bericht<\/h3><\/div><div id=\"field_2_6\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_2_6'>Vraag \/ Opmerking<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_6' id='input_2_6' class='textarea large'    placeholder='Vraag \/ Opmerking *' aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_2_5\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Toestemming<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_5.1' id='input_2_5_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_2_5\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_5_1' >Ik heb de <a href=\"\/nl\/privacybeleid\/\" target=\"_blank\">privacybeleid<\/a><span class=\"gfield_required gfield_required_text\">(Verplicht)<\/span><\/label><input type='hidden' name='input_5.2' value='He le\u00eddo y acepto la &lt;a href=&quot;\/politica-de-privacidad\/&quot; target=&quot;_blank&quot;&gt;pol\u00edtica de privacidad&lt;\/a&gt;' class='gform_hidden' \/><input type='hidden' name='input_5.3' value='3' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_2_5' tabindex='0'>MARIA ALEXANDRA RODRIGUEZ CORTES als eigenaar van clinicabenissa.com vraag ik uw toestemming om de vragen te beantwoorden die via het formulier worden gesteld. De gegevens worden niet doorgegeven aan derden, behalve in gevallen waar er een wettelijke verplichting bestaat. In ieder geval worden de gegevens die u ons verstrekt opgeslagen op servers waarvan het hoofdkantoor zich binnen de EU bevindt. In het geval van niet-EU-landen zullen we u vooraf informeren en dit alleen doen met uw uitdrukkelijke toestemming of door middel van standaard contractuele clausules voor de overdracht van persoonlijke gegevens tussen verantwoordelijken voor de verwerking naar een derde land. Door gebruik te maken van Google Fonts is het mogelijk dat sommige van uw gegevens (zoals uw IP-adres) worden verwerkt om de betreffende dienst te kunnen leveren. 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