{"id":27013,"date":"2025-07-22T00:55:52","date_gmt":"2025-07-21T22:55:52","guid":{"rendered":"https:\/\/heartfulness.be\/?page_id=27013"},"modified":"2025-07-22T00:56:44","modified_gmt":"2025-07-21T22:56:44","slug":"registration-form-heart-coherence","status":"publish","type":"page","link":"https:\/\/heartfulness.be\/en\/registration-form-heart-coherence\/","title":{"rendered":"Registration form heart coherence"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"27013\" class=\"elementor elementor-27013 elementor-26996\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d9e972f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d9e972f\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-65f267b\" data-id=\"65f267b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-11db4fa2 elementor-widget elementor-widget-text-editor\" data-id=\"11db4fa2\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\n\n\n\n\n\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-364d4a2 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"364d4a2\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-065e5fc\" data-id=\"065e5fc\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-9c36c91 elementor-widget elementor-widget-wpforms\" data-id=\"9c36c91\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full wpforms-render-modern\" id=\"wpforms-26989\"><form id=\"wpforms-form-26989\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"26989\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/27013\" data-token=\"01325a8349e8959da5fb7950116f6c73\" data-token-time=\"1794046220\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-26989-field_19-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"19\"><div id=\"wpforms-26989-field_19\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-26989-field_19-error\"><h4>Vul hier je gegevens in<\/h4>\n<p style=\"text-align:justify\">Je hebt interesse om een hartcoherentie training te volgen? Dan kan je het formulier hieronder invullen.<\/p>\n<p style=\"text-align:justify\">\nVul hieronder alle nodige gegevens in om je in te schrijven. Dit formulier is strikt persoonlijk en wordt ook in de context van het beroepsgeheim vertrouwelijk behandeld. Alle medische dossiers worden uitsluitend en alleen door mezelf, Dirk Vieren, gelezen.<\/p>\n<p style=\"text-align:justify\">Je zal ook een uitnodiging krijgen om een 4DKL lijst in te vullen. Hierover meer in de mail die zal volgen.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-26989-field_20-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"20\"><h3 id=\"wpforms-26989-field_20\" aria-errormessage=\"wpforms-26989-field_20-error\">PERSOONLIJKE GEGEVENS<\/h3><\/div><div id=\"wpforms-26989-field_1-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"1\"><fieldset><legend class=\"wpforms-field-label\">Je naam <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-26989-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-26989-field_1-error\" required><label for=\"wpforms-26989-field_1\" class=\"wpforms-field-sublabel after\">Voornaam<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-26989-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-26989-field_1-last-error\" required><label for=\"wpforms-26989-field_1-last\" class=\"wpforms-field-sublabel after\">Achternaam<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-26989-field_14-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">Adres <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-26989-field_14\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][14][address1]\" aria-errormessage=\"wpforms-26989-field_14-error\" required><label for=\"wpforms-26989-field_14\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-26989-field_14-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][14][address2]\" aria-errormessage=\"wpforms-26989-field_14-address2-error\" ><label for=\"wpforms-26989-field_14-address2\" class=\"wpforms-field-sublabel after\">Address Line 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-26989-field_14-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][14][city]\" aria-errormessage=\"wpforms-26989-field_14-city-error\" required><label for=\"wpforms-26989-field_14-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-26989-field_14-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][14][state]\" aria-errormessage=\"wpforms-26989-field_14-state-error\" required><label for=\"wpforms-26989-field_14-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-26989-field_14-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][14][postal]\" aria-errormessage=\"wpforms-26989-field_14-postal-error\" required><label for=\"wpforms-26989-field_14-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-26989-field_14-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][14][country]\" aria-errormessage=\"wpforms-26989-field_14-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\" >Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-26989-field_14-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-26989-field_16-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_16\">Telefoon <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-26989-field_16\" class=\"wpforms-field-medium wpforms-field-required wpforms-smart-phone-field\" data-rule-smart-phone-field=\"true\" name=\"wpforms[fields][16]\" aria-label=\"Telefoon\" aria-errormessage=\"wpforms-26989-field_16-error\" required><\/div><div id=\"wpforms-26989-field_17-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_17\">Geboortedatum <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-26989-field_17\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"d\/m\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][17][date]\" aria-errormessage=\"wpforms-26989-field_17-error\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-26989-field_8-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_8\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-26989-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" spellcheck=\"false\" aria-errormessage=\"wpforms-26989-field_8-error\" required><\/div><div id=\"wpforms-26989-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_21\">Opleiding<\/label><input type=\"text\" id=\"wpforms-26989-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-26989-field_21-error\" aria-describedby=\"wpforms-26989-field_21-description\" ><div id=\"wpforms-26989-field_21-description\" class=\"wpforms-field-description\">Wat is je opleiding?<\/div><\/div><div id=\"wpforms-26989-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_22\">Beroep<\/label><input type=\"text\" id=\"wpforms-26989-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-26989-field_22-error\" aria-describedby=\"wpforms-26989-field_22-description\" ><div id=\"wpforms-26989-field_22-description\" class=\"wpforms-field-description\">Wat is je beroep?<\/div><\/div><div id=\"wpforms-26989-field_23-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-type=\"select\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_23\">Sociale status<\/label><select id=\"wpforms-26989-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\"><option value=\"Gehuwd\"  class=\"choice-1 depth-1\"  >Gehuwd<\/option><option value=\"Samenwonend\"  class=\"choice-2 depth-1\"  >Samenwonend<\/option><option value=\"Gescheiden\"  class=\"choice-3 depth-1\"  >Gescheiden<\/option><option value=\"Singel\"  class=\"choice-4 depth-1\"  >Singel<\/option><option value=\"Weduw(e)naar\"  class=\"choice-5 depth-1\"  >Weduw(e)naar<\/option><\/select><\/div><div id=\"wpforms-26989-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_24\">Kinderen (aantal)<\/label><input type=\"text\" id=\"wpforms-26989-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-26989-field_24-error\" aria-describedby=\"wpforms-26989-field_24-description\" ><div id=\"wpforms-26989-field_24-description\" class=\"wpforms-field-description\">Hoeveel kinderen heb je?<\/div><\/div><div id=\"wpforms-26989-field_25-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"25\"><h3 id=\"wpforms-26989-field_25\" aria-errormessage=\"wpforms-26989-field_25-error\">INFORMATIE OVER DE TRAINING<\/h3><\/div><div id=\"wpforms-26989-field_4-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">Hoe wil je deelnemen aan een hartcoherentie training? Individuele sessies of in groep in de heartfulness module &quot;The Physical Heart&quot;? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-26989-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26989-field_4_1\" name=\"wpforms[fields][4]\" value=\"Hartcoherentie individueel\" aria-errormessage=\"wpforms-26989-field_4_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_4_1\">Hartcoherentie individueel<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26989-field_4_2\" name=\"wpforms[fields][4]\" value=\"Heartfulness module &quot;The Physical Heart&quot;\" aria-errormessage=\"wpforms-26989-field_4_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_4_2\">Heartfulness module \"The Physical Heart\"<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26989-field_31-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_31\">Wat is je belangrijkste motivatie om deel te nemen?<\/label><textarea id=\"wpforms-26989-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" aria-errormessage=\"wpforms-26989-field_31-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_32-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_32\">Wie heeft je verwezen?<\/label><textarea id=\"wpforms-26989-field_32\" class=\"wpforms-field-medium\" name=\"wpforms[fields][32]\" aria-errormessage=\"wpforms-26989-field_32-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_34-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_34\">Ben je bereid dagelijks 3 x 5 min. te oefenen? Zo neen, wat zijn de barri\u00e8res?<\/label><textarea id=\"wpforms-26989-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-26989-field_34-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_36-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_36\">Doe je ook andere ontspanningsoefeningen of meditatie? Specifieer aub.<\/label><textarea id=\"wpforms-26989-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-26989-field_36-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_37-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"37\"><h3 id=\"wpforms-26989-field_37\" aria-errormessage=\"wpforms-26989-field_37-error\">MEDISCH DOSSIER<\/h3><\/div><div id=\"wpforms-26989-field_38-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_38\">Uw huidige klacht?<\/label><textarea id=\"wpforms-26989-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-26989-field_38-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_41-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_41\">Vroegere psychische aandoeningen waarvoor je werd behandeld? Specifieer.<\/label><textarea id=\"wpforms-26989-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-26989-field_41-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_42-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_42\">Heb je depressies doorgemaakt? Zo ja, hoeveel en wanneer?<\/label><textarea id=\"wpforms-26989-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" aria-errormessage=\"wpforms-26989-field_42-error\" ><\/textarea><\/div>\t\t<div id=\"wpforms-26989-field_2-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"2\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-26989-field_2\" >terugvallen je Zie<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-26989-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-26989-field_50-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_50\">Ben je op dit moment in behandeling bij een arts, psycholoog, psychiater of andere hulpverlener? Waarom? Hoe frequent? Specifieer aub.<\/label><textarea id=\"wpforms-26989-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-26989-field_50-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_51-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_51\">Is er iemand op wie je kunt terugvallen voor professionele ondersteuning? Specifieer.<\/label><textarea id=\"wpforms-26989-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\" aria-errormessage=\"wpforms-26989-field_51-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_52-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"52\"><fieldset><legend class=\"wpforms-field-label\">Ben je momenteel in ziekenverlof?<\/legend><ul id=\"wpforms-26989-field_52\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26989-field_52_1\" name=\"wpforms[fields][52]\" value=\"Ja\" aria-errormessage=\"wpforms-26989-field_52_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_52_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26989-field_52_2\" name=\"wpforms[fields][52]\" value=\"Nee\" aria-errormessage=\"wpforms-26989-field_52_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_52_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26989-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_54\">Gebruik je op dit moment medicatie? Zo ja, wat en hoe vaak?<\/label><textarea id=\"wpforms-26989-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-26989-field_54-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_7-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-26989-field_7\">Is er nog iets waarvan je wilt dat de trainer het weet?<\/label><textarea id=\"wpforms-26989-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-26989-field_7-error\" ><\/textarea><\/div><div id=\"wpforms-26989-field_26-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"26\"><fieldset><legend class=\"wpforms-field-label\">Hoe heb je hartcoherentie leren kennen?  <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-26989-field_26\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_1\" name=\"wpforms[fields][26][]\" value=\"Via verwijzing arts. Schrijf hierboven naam van de arts\" aria-errormessage=\"wpforms-26989-field_26_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_1\">Via verwijzing arts. Schrijf hierboven naam van de arts<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_7\" name=\"wpforms[fields][26][]\" value=\"Via vrienden of kennissen\" aria-errormessage=\"wpforms-26989-field_26_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_7\">Via vrienden of kennissen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_2\" name=\"wpforms[fields][26][]\" value=\"Via iemand die dit ook gevolgd heeft\" aria-errormessage=\"wpforms-26989-field_26_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_2\">Via iemand die dit ook gevolgd heeft<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_9\" name=\"wpforms[fields][26][]\" value=\"Via de website heartfulness.be\" aria-errormessage=\"wpforms-26989-field_26_9-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_9\">Via de website heartfulness.be<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_3\" name=\"wpforms[fields][26][]\" value=\"Gezien op TV\" aria-errormessage=\"wpforms-26989-field_26_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_3\">Gezien op TV<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_4\" name=\"wpforms[fields][26][]\" value=\"Gevonden op Google\" aria-errormessage=\"wpforms-26989-field_26_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_4\">Gevonden op Google<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_5\" name=\"wpforms[fields][26][]\" value=\"Artikel in boek, tijdschrift, krant..\" aria-errormessage=\"wpforms-26989-field_26_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_5\">Artikel in boek, tijdschrift, krant..<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_10\" name=\"wpforms[fields][26][]\" value=\"Folder\" aria-errormessage=\"wpforms-26989-field_26_10-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_10\">Folder<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_26_8\" name=\"wpforms[fields][26][]\" value=\"Andere\" aria-errormessage=\"wpforms-26989-field_26_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_26_8\">Andere<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26989-field_28-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"28\"><fieldset><legend class=\"wpforms-field-label\">Ik ben ervan bewust dat een hartcoherentie training een aanvulling is op medicamenteuze en psychologische behandeling en niet een vervanging ervan. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-26989-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26989-field_28_1\" name=\"wpforms[fields][28]\" value=\"Ja\" aria-errormessage=\"wpforms-26989-field_28_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_28_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26989-field_28_2\" name=\"wpforms[fields][28]\" value=\"Nee\" aria-errormessage=\"wpforms-26989-field_28_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_28_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26989-field_27-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-type=\"checkbox\" data-field-id=\"27\"><fieldset><legend class=\"wpforms-field-label\">Ik heb de annuleringsvoorwaarden gelezen en ga akkoord. Zie algemene voorwaarden. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-26989-field_27\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-26989-field_27_1\" name=\"wpforms[fields][27][]\" value=\"Ja\" aria-errormessage=\"wpforms-26989-field_27_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26989-field_27_1\">Ja<\/label><\/li><\/ul><\/fieldset><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-26989-field_2-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-26989-field_2-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-26989-field_2-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"26989\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1794046220.daa83dcd19c0e4fa964ef7d2cfbbaa8a9af078a8eddaa0aa56f2b64d4ad5ff26\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/heartfulness.be\/en\/wp-json\/wp\/v2\/pages\/27013\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-26989\" class=\"wpforms-submit\" data-alt-text=\"Wordt verstuurd... Bedankt! ;-)\" data-submit-text=\"Ik schrijf mij in\" aria-live=\"assertive\" value=\"wpforms-submit\">Ik schrijf mij in<\/button><img decoding=\"async\" src=\"https:\/\/heartfulness.be\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Schakel JavaScript in uw browser in om dit formulier in te vullen.Schakel JavaScript in uw browser in om dit formulier in te vullen. Vul hier je gegevens in Je hebt interesse om een hartcoherentie training te volgen? Dan kan je het formulier hieronder invullen. Vul hieronder alle nodige gegevens in om je in te schrijven. [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-27013","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Registration form heart coherence &#8902; Levensstroom<\/title>\n<meta name=\"description\" content=\"Registration form heart coherence training in individual guidance or heartfulness training module 1: The Physical Heart\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/heartfulness.be\/en\/registration-form-heart-coherence\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Registration form heart coherence &#8902; 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