{"id":27008,"date":"2025-07-22T00:46:57","date_gmt":"2025-07-21T22:46:57","guid":{"rendered":"https:\/\/heartfulness.be\/?page_id=27008"},"modified":"2026-09-22T20:46:10","modified_gmt":"2026-09-22T18:46:10","slug":"formulaire-dinscription-a-la-pleine-conscience","status":"publish","type":"page","link":"https:\/\/heartfulness.be\/fr\/formulaire-dinscription-a-la-pleine-conscience\/","title":{"rendered":"Formulaire d&rsquo;inscription \u00e0 la pleine conscience"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"27008\" class=\"elementor elementor-27008 elementor-26878 elementor-bc-flex-widget\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-f060b79 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"f060b79\" 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-12d536b\" data-id=\"12d536b\" 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-c530257 elementor-widget elementor-widget-wpforms\" data-id=\"c530257\" 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-26864\"><form id=\"wpforms-form-26864\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"26864\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/fr\/wp-json\/wp\/v2\/pages\/27008\" data-token=\"52f34371b94338a41385e1c4164b26db\" data-token-time=\"1791848382\"><noscript class=\"wpforms-error-noscript\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-26864-field_19-container\" class=\"wpforms-field wpforms-field-content\" data-field-type=\"content\" data-field-id=\"19\"><div id=\"wpforms-26864-field_19\" class=\"wpforms-field-medium wpforms-field-row\" aria-errormessage=\"wpforms-26864-field_19-error\"><h4>Vul hier je gegevens in<\/h4>\n<p>Je hebt interesse om deel te nemen aan een <strong>info avond, kennismakingsavond over mindfulness, of een training? Of een heartfulness training<\/strong>? Dan kan je het formulier hieronder invullen.<\/p>\n<p style=\"text-align:justify\">De trainingen zijn voor iedereen, of je nu gezond bent en gelukkig of gestresseerd en ziek!<br \/>\nVul hieronder alle nodige gegevens in om je in te schrijven. Deze lijst zal gebruikt worden indien een intakegesprek noodzakelijk is. 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, trainer van deze mindfulness sessies, gelezen. En alle e-mails komen rechtstreeks bij mij.<\/p>\n<p>Lukt het je niet om dit formulier ingevuld te krijgen omwille van computerproblemen of heb je wat weerstand om dit dossier in te vullen, neem dan even contact met me op: +32 (0)56 444796. Bij het doornemen van de lijst kan je de indruk krijgen dat je ziek moet zijn om te kunnen deelnemen! Dit is niet zo! Vul in het medisch dossier datgene in wat je denkt dat belangrijk is voor mij.<\/p>\n<div class=\"wpforms-field-content-display-frontend-clear\"><\/div><\/div><\/div><div id=\"wpforms-26864-field_20-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"20\"><h3 id=\"wpforms-26864-field_20\" aria-errormessage=\"wpforms-26864-field_20-error\">PERSOONLIJKE GEGEVENS<\/h3><\/div><div id=\"wpforms-26864-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-26864-field_1\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][1][first]\" aria-errormessage=\"wpforms-26864-field_1-error\" required><label for=\"wpforms-26864-field_1\" class=\"wpforms-field-sublabel after\">Voornaam<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-26864-field_1-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][1][last]\" aria-errormessage=\"wpforms-26864-field_1-last-error\" required><label for=\"wpforms-26864-field_1-last\" class=\"wpforms-field-sublabel after\">Achternaam<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-26864-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-26864-field_14\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][14][address1]\" aria-errormessage=\"wpforms-26864-field_14-error\" required><label for=\"wpforms-26864-field_14\" class=\"wpforms-field-sublabel after\">Ligne d\u2019adresse 2<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-26864-field_14-address2\" class=\"wpforms-field-address-address2\" name=\"wpforms[fields][14][address2]\" aria-errormessage=\"wpforms-26864-field_14-address2-error\" ><label for=\"wpforms-26864-field_14-address2\" class=\"wpforms-field-sublabel after\">Ligne d\u2019adresse 1<\/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-26864-field_14-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][14][city]\" aria-errormessage=\"wpforms-26864-field_14-city-error\" required><label for=\"wpforms-26864-field_14-city\" class=\"wpforms-field-sublabel after\">Ville<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-26864-field_14-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][14][state]\" aria-errormessage=\"wpforms-26864-field_14-state-error\" required><label for=\"wpforms-26864-field_14-state\" class=\"wpforms-field-sublabel after\">\u00c9tat \/ Province \/ R\u00e9gion<\/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-26864-field_14-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][14][postal]\" aria-errormessage=\"wpforms-26864-field_14-postal-error\" required><label for=\"wpforms-26864-field_14-postal\" class=\"wpforms-field-sublabel after\">Code postal<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-26864-field_14-country\" class=\"wpforms-field-address-country wpforms-field-required\" name=\"wpforms[fields][14][country]\" aria-errormessage=\"wpforms-26864-field_14-country-error\" required><option class=\"placeholder\" value=\"\" selected disabled>--- S\u00e9lectionnez country ---<\/option><option value=\"AF\" >Afghanistan<\/option><option value=\"ZA\" >Afrique du Sud<\/option><option value=\"AL\" >Albanie<\/option><option value=\"DZ\" >Alg\u00e9rie<\/option><option value=\"DE\" >Allemagne<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorre<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctique<\/option><option value=\"AG\" >Antigua-et-Barbuda<\/option><option value=\"SA\" >Arabie Saoudite<\/option><option value=\"AR\" >Argentine<\/option><option value=\"AM\" >Arm\u00e9nie<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australie<\/option><option value=\"AT\" >Autriche<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbades<\/option><option value=\"BE\" >Belgique<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermudes<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BY\" >Bi\u00e9lorussie<\/option><option value=\"BO\" >Bolivie (\u00c9tat plurinational de)<\/option><option value=\"BA\" >Bosnie-Herz\u00e9govine<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BR\" >Br\u00e9sil<\/option><option value=\"BG\" >Bulgarie<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"KH\" >Cambodge<\/option><option value=\"CM\" >Cameroun<\/option><option value=\"CA\" >Canada<\/option><option value=\"CV\" >Cap-Vert<\/option><option value=\"CL\" >Chili<\/option><option value=\"CN\" >Chine<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CY\" >Chypre<\/option><option value=\"CO\" >Colombie<\/option><option value=\"KM\" >Comores<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (R\u00e9publique d\u00e9mocratique du)<\/option><option value=\"KR\" >Cor\u00e9e (R\u00e9publique du)<\/option><option value=\"KP\" >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique du)<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatie<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Danemark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominique<\/option><option value=\"ER\" >Erythr\u00e9e<\/option><option value=\"ES\" >Espagne<\/option><option value=\"EE\" >Estonie<\/option><option value=\"SZ\" >Eswatini (Royaume de)<\/option><option value=\"FJ\" >Fidji<\/option><option value=\"FI\" >Finlande<\/option><option value=\"FR\" >France<\/option><option value=\"RU\" >F\u00e9d\u00e9ration de Russie<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambie<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GD\" >Grenade<\/option><option value=\"GL\" >Groenland<\/option><option value=\"GR\" >Gr\u00e8ce<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernesey<\/option><option value=\"GN\" >Guin\u00e9e<\/option><option value=\"GQ\" >Guin\u00e9e \u00e9quatoriale<\/option><option value=\"GW\" >Guin\u00e9e-Bissau<\/option><option value=\"GY\" >Guyane<\/option><option value=\"GF\" >Guyane Fran\u00e7aise<\/option><option value=\"GE\" >G\u00e9orgie<\/option><option value=\"GS\" >G\u00e9orgie du Sud et \u00eeles Sandwich du Sud<\/option><option value=\"HT\" >Ha\u00efti<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hongrie<\/option><option value=\"IN\" >Inde<\/option><option value=\"ID\" >Indon\u00e9sie<\/option><option value=\"IR\" >Iran (R\u00e9publique islamique d&#039;)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Irlande (R\u00e9publique d&#039;)<\/option><option value=\"IS\" >Islande<\/option><option value=\"IL\" >Isra\u00ebl<\/option><option value=\"IT\" >Italie<\/option><option value=\"JM\" >Jama\u00efque<\/option><option value=\"JP\" >Japon<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordanie<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kowe\u00eft<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LV\" >Lettonie<\/option><option value=\"LB\" >Liban<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libye<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lituanie<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MK\" >Mac\u00e9doine du Nord (R\u00e9publique de)<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MY\" >Malaisie<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malte<\/option><option value=\"MA\" >Maroc<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MU\" >Maurice<\/option><option value=\"MR\" >Mauritanie<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexique<\/option><option value=\"FM\" >Micron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)<\/option><option value=\"MD\" >Moldavi\u00eb (Republiek)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolie<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibie<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norv\u00e8ge<\/option><option value=\"NC\" >Nouvelle-Cal\u00e9donie<\/option><option value=\"NZ\" >Nouvelle-Z\u00e9lande<\/option><option value=\"NP\" >N\u00e9pal<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (\u00c9tat de)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"NL\" >Pays-Bas<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Pologne<\/option><option value=\"PF\" >Polyn\u00e9sie Fran\u00e7aise<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"PE\" >P\u00e9rou<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Roumanie<\/option><option value=\"GB\" >Royaume-Uni de Grande-Bretagne et d\u2019Irlande du Nord<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"CF\" >R\u00e9publique Centrafricaine<\/option><option value=\"DO\" >R\u00e9publique Dominicaine<\/option><option value=\"CZ\" >R\u00e9publique Tch\u00e8que<\/option><option value=\"SY\" >R\u00e9publique arabe syrienne<\/option><option value=\"LA\" >R\u00e9publique d\u00e9mocratique populaire lao<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BQ\" >Saba, Saint-Eustache et Bonaire<\/option><option value=\"EH\" >Sahara occidental<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"PM\" >Saint Pierre et Miquelon<\/option><option value=\"KN\" >Saint-Kitts-et-Nevis<\/option><option value=\"MF\" >Saint-Martin (partie fran\u00e7aise)<\/option><option value=\"VC\" >Saint-Vincent-et-les-Grenadines<\/option><option value=\"SH\" >Sainte-H\u00e9l\u00e8ne, l\u2019Ascension et Tristan da Cunha<\/option><option value=\"LC\" >Sainte-Lucie<\/option><option value=\"SV\" >Salvador<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tom\u00e9-et-Principe<\/option><option value=\"RS\" >Serbie<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapour<\/option><option value=\"SX\" >Sint Maarten (partie n\u00e9erlandaise)<\/option><option value=\"SK\" >Slovaquie<\/option><option value=\"SI\" >Slov\u00e9nie<\/option><option value=\"SO\" >Somalie<\/option><option value=\"SD\" >Soudan<\/option><option value=\"SS\" >Soudan du Sud<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"CH\" >Suisse<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SE\" >Su\u00e8de<\/option><option value=\"SJ\" >Svalbard et Jan Mayen<\/option><option value=\"SN\" >S\u00e9n\u00e9gal<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzanie (R\u00e9publique-Unie de)<\/option><option value=\"TW\" >Ta\u00efwan, R\u00e9publique de Chine<\/option><option value=\"TD\" >Tchad<\/option><option value=\"TF\" >Terres Australes Fran\u00e7aises<\/option><option value=\"IO\" >Territoire britannique de l&rsquo;oc\u00e9an Indien<\/option><option value=\"TH\" >Thailande<\/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\" >Trinit\u00e9-et-Tobago<\/option><option value=\"TN\" >Tunisie<\/option><option value=\"TM\" >Turkm\u00e9nistan<\/option><option value=\"TR\" >Turquie<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VE\" >Venezuela (R\u00e9publique bolivarienne du)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"WF\" >Wallis et Futuna<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambie<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><option value=\"EG\" >\u00c9gypte<\/option><option value=\"AE\" >\u00c9mirats Arabes Unis<\/option><option value=\"EC\" >\u00c9quateur<\/option><option value=\"VA\" >\u00c9tat de la Cit\u00e9 du Vatican<\/option><option value=\"US\" >\u00c9tats-Unis d\u2019Am\u00e9rique<\/option><option value=\"ET\" >\u00c9thiopie<\/option><option value=\"BV\" >\u00cele Bouvet<\/option><option value=\"NF\" >\u00cele Norfolk<\/option><option value=\"IM\" >\u00cele de Man<\/option><option value=\"KY\" >\u00celes Ca\u00efmans<\/option><option value=\"CC\" >\u00celes Cocos<\/option><option value=\"CK\" >\u00celes Cook<\/option><option value=\"FO\" >\u00celes F\u00e9ro\u00e9<\/option><option value=\"HM\" >\u00celes Heard-et-MacDonald<\/option><option value=\"FK\" >\u00celes Malouines (Malvinas)<\/option><option value=\"MH\" >\u00celes Marshall<\/option><option value=\"SB\" >\u00celes Salomon<\/option><option value=\"TC\" >\u00celes Turques et Ca\u00efques<\/option><option value=\"VI\" >\u00celes Vierges (U.S.)<\/option><option value=\"VG\" >\u00celes Vierges (britanniques)<\/option><option value=\"UM\" >\u00celes mineures \u00e9loign\u00e9es des \u00c9tats-Unis<\/option><\/select><label for=\"wpforms-26864-field_14-country\" class=\"wpforms-field-sublabel after\">Pays<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-26864-field_16-container\" class=\"wpforms-field wpforms-field-phone\" data-field-type=\"phone\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_16\">Telefoon <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"tel\" id=\"wpforms-26864-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-26864-field_16-error\" required><\/div><div id=\"wpforms-26864-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-26864-field_17\">Geboortedatum<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-26864-field_17\" class=\"wpforms-field-date-time-date wpforms-datepicker 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-26864-field_17-error\" ><a title=\"Effacer la date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Effacer la date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-26864-field_8-container\" class=\"wpforms-field wpforms-field-email\" data-field-type=\"email\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_8\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-26864-field_8\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][8]\" spellcheck=\"false\" aria-errormessage=\"wpforms-26864-field_8-error\" required><\/div><div id=\"wpforms-26864-field_21-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"21\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_21\">Opleiding<\/label><input type=\"text\" id=\"wpforms-26864-field_21\" class=\"wpforms-field-medium\" name=\"wpforms[fields][21]\" aria-errormessage=\"wpforms-26864-field_21-error\" aria-describedby=\"wpforms-26864-field_21-description\" ><div id=\"wpforms-26864-field_21-description\" class=\"wpforms-field-description\">Wat is je opleiding?<\/div><\/div><div id=\"wpforms-26864-field_22-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_22\">Beroep<\/label><input type=\"text\" id=\"wpforms-26864-field_22\" class=\"wpforms-field-medium\" name=\"wpforms[fields][22]\" aria-errormessage=\"wpforms-26864-field_22-error\" aria-describedby=\"wpforms-26864-field_22-description\" ><div id=\"wpforms-26864-field_22-description\" class=\"wpforms-field-description\">Wat is je beroep?<\/div><\/div><div id=\"wpforms-26864-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-26864-field_23\">Sociale status<\/label><select id=\"wpforms-26864-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-26864-field_24-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_24\">Kinderen (aantal)<\/label><input type=\"text\" id=\"wpforms-26864-field_24\" class=\"wpforms-field-medium\" name=\"wpforms[fields][24]\" aria-errormessage=\"wpforms-26864-field_24-error\" aria-describedby=\"wpforms-26864-field_24-description\" ><div id=\"wpforms-26864-field_24-description\" class=\"wpforms-field-description\">Hoeveel kinderen heb je?<\/div><\/div><div id=\"wpforms-26864-field_25-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"25\"><h3 id=\"wpforms-26864-field_25\" aria-errormessage=\"wpforms-26864-field_25-error\">INFORMATIE OVER DE TRAINING<\/h3><\/div>\t\t<div id=\"wpforms-26864-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-26864-field_2\" >en je met<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-26864-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-26864-field_4-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"4\"><fieldset><legend class=\"wpforms-field-label\">Waar en wanneer wil je deelnemen aan een mindfulness training? Er gaan trainingen door in Moorsele (Kortrijk), Oudenburg (Oostende) en Roeselare. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-26864-field_4\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_4_1\" name=\"wpforms[fields][4]\" value=\"Online lezing wat is heartfulness - Dinsdag 8 september 2026\" aria-errormessage=\"wpforms-26864-field_4_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_4_1\">Online lezing wat is heartfulness - Dinsdag 8 september 2026<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_4_5\" name=\"wpforms[fields][4]\" value=\"Mindfulness training Roeselare - Maandag 28 september 2026\" aria-errormessage=\"wpforms-26864-field_4_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_4_5\">Mindfulness training Roeselare - Maandag 28 september 2026<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_4_6\" name=\"wpforms[fields][4]\" value=\"Mindfulness training Moorsele - Dinsdag 3 november 2026\" aria-errormessage=\"wpforms-26864-field_4_6-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_4_6\">Mindfulness training Moorsele - Dinsdag 3 november 2026<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_4_4\" name=\"wpforms[fields][4]\" value=\"Mindfulness training Online - Woensdag 4 november 2026\" aria-errormessage=\"wpforms-26864-field_4_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_4_4\">Mindfulness training Online - Woensdag 4 november 2026<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_4_3\" name=\"wpforms[fields][4]\" value=\"Heartfulness module 1: het fysieke hart - Gent, datum komt\" aria-errormessage=\"wpforms-26864-field_4_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_4_3\">Heartfulness module 1: het fysieke hart - Gent, datum komt<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_4_2\" name=\"wpforms[fields][4]\" value=\"Kennismaking online wat is mindfulness\" aria-errormessage=\"wpforms-26864-field_4_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_4_2\">Kennismaking online wat is mindfulness<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_30-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"30\"><fieldset><legend class=\"wpforms-field-label\">Kan je aan alle lessen deelnemen? Zo niet, geef dan aan welke dag(en) niet, in het vak onderaan dit formulier: &#039;Is er nog iets waarvan je wilt dat de trainer het weet?&#039;<\/legend><ul id=\"wpforms-26864-field_30\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_30_1\" name=\"wpforms[fields][30]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_30_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_30_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_30_2\" name=\"wpforms[fields][30]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_30_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_30_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_31-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_31\">Wat is je belangrijkste motivatie om deel te nemen?<\/label><textarea id=\"wpforms-26864-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" aria-errormessage=\"wpforms-26864-field_31-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_32-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"32\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_32\">Wie heeft je verwezen?<\/label><textarea id=\"wpforms-26864-field_32\" class=\"wpforms-field-medium\" name=\"wpforms[fields][32]\" aria-errormessage=\"wpforms-26864-field_32-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_33-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"33\"><fieldset><legend class=\"wpforms-field-label\">Neem je deel aan de mindfulness training om te voldoen aan de verwachtingen van de persoon die je de training heeft aangeraden?<\/legend><ul id=\"wpforms-26864-field_33\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_33_1\" name=\"wpforms[fields][33]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_33_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_33_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_33_2\" name=\"wpforms[fields][33]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_33_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_33_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_34-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"34\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_34\">Ben je bereid dagelijks 45 min. tot 1 uur te oefenen? Zo neen, wat zijn de barri\u00e8res?<\/label><textarea id=\"wpforms-26864-field_34\" class=\"wpforms-field-medium\" name=\"wpforms[fields][34]\" aria-errormessage=\"wpforms-26864-field_34-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_35-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"35\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_35\">Heb je ervaring met zen, vipassana of een andere vorm van meditatie? Specifieer aub.<\/label><textarea id=\"wpforms-26864-field_35\" class=\"wpforms-field-medium\" name=\"wpforms[fields][35]\" aria-errormessage=\"wpforms-26864-field_35-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_36-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"36\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_36\">Ben je van plan een andere praktijk van ontspanningsoefeningen of meditatie te beoefenen tijdens deelname aan MBCT training? Specifieer aub.<\/label><textarea id=\"wpforms-26864-field_36\" class=\"wpforms-field-medium\" name=\"wpforms[fields][36]\" aria-errormessage=\"wpforms-26864-field_36-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_37-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"37\"><h3 id=\"wpforms-26864-field_37\" aria-errormessage=\"wpforms-26864-field_37-error\">MEDISCH DOSSIER<\/h3><\/div><div id=\"wpforms-26864-field_38-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"38\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_38\">Heb je vroeger een lichamelijke aandoening gehad? Specifieer.<\/label><textarea id=\"wpforms-26864-field_38\" class=\"wpforms-field-medium\" name=\"wpforms[fields][38]\" aria-errormessage=\"wpforms-26864-field_38-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_39-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"39\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_39\">En op dit moment? Specifeer.<\/label><textarea id=\"wpforms-26864-field_39\" class=\"wpforms-field-medium\" name=\"wpforms[fields][39]\" aria-errormessage=\"wpforms-26864-field_39-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_40-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"40\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_40\">Heb je op dit moment een psychische aandoening waarvoor je behandeld wordt? Specifieer.<\/label><textarea id=\"wpforms-26864-field_40\" class=\"wpforms-field-medium\" name=\"wpforms[fields][40]\" aria-errormessage=\"wpforms-26864-field_40-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_41-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"41\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_41\">Vroegere psychische aandoeningen waarvoor je werd behandeld? Specifieer.<\/label><textarea id=\"wpforms-26864-field_41\" class=\"wpforms-field-medium\" name=\"wpforms[fields][41]\" aria-errormessage=\"wpforms-26864-field_41-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_42-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"42\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_42\">Heb je depressies doorgemaakt? Zo ja, hoeveel en wanneer?<\/label><textarea id=\"wpforms-26864-field_42\" class=\"wpforms-field-medium\" name=\"wpforms[fields][42]\" aria-errormessage=\"wpforms-26864-field_42-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_43-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"43\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_43\">Ben je op dit moment stabiel? Zo ja, sinds hoe lang?<\/label><textarea id=\"wpforms-26864-field_43\" class=\"wpforms-field-medium\" name=\"wpforms[fields][43]\" aria-errormessage=\"wpforms-26864-field_43-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_44-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"44\"><fieldset><legend class=\"wpforms-field-label\">Heb je de neiging om te piekeren?<\/legend><ul id=\"wpforms-26864-field_44\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_44_1\" name=\"wpforms[fields][44]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_44_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_44_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_44_2\" name=\"wpforms[fields][44]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_44_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_44_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_45-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"45\"><fieldset><legend class=\"wpforms-field-label\">Ervaar je snel negatieve gedachten?<\/legend><ul id=\"wpforms-26864-field_45\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_45_1\" name=\"wpforms[fields][45]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_45_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_45_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_45_2\" name=\"wpforms[fields][45]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_45_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_45_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_46-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"46\"><fieldset><legend class=\"wpforms-field-label\">Wanneer je stemming minder goed is, vraag je je dan af hoe alles zal aflopen?<\/legend><ul id=\"wpforms-26864-field_46\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_46_1\" name=\"wpforms[fields][46]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_46_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_46_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_46_2\" name=\"wpforms[fields][46]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_46_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_46_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_47-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"47\"><fieldset><legend class=\"wpforms-field-label\">Wanneer je stemming minder goed is, ga je dan je emotie analyseren?<\/legend><ul id=\"wpforms-26864-field_47\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_47_1\" name=\"wpforms[fields][47]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_47_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_47_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_47_2\" name=\"wpforms[fields][47]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_47_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_47_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_48-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"48\"><fieldset><legend class=\"wpforms-field-label\">Heb je de indruk dat je bijna uitsluitend zware, negatieve gedachten ervaart?<\/legend><ul id=\"wpforms-26864-field_48\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_48_1\" name=\"wpforms[fields][48]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_48_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_48_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_48_2\" name=\"wpforms[fields][48]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_48_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_48_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_49-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"49\"><fieldset><legend class=\"wpforms-field-label\">Ben je op dit moment overwegend somber gestemd?<\/legend><ul id=\"wpforms-26864-field_49\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_49_1\" name=\"wpforms[fields][49]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_49_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_49_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_49_2\" name=\"wpforms[fields][49]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_49_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_49_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_50-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"50\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-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-26864-field_50\" class=\"wpforms-field-medium\" name=\"wpforms[fields][50]\" aria-errormessage=\"wpforms-26864-field_50-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_51-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"51\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_51\">Is er iemand op wie je kunt terugvallen voor professionele ondersteuning? Specifieer.<\/label><textarea id=\"wpforms-26864-field_51\" class=\"wpforms-field-medium\" name=\"wpforms[fields][51]\" aria-errormessage=\"wpforms-26864-field_51-error\" ><\/textarea><\/div><div id=\"wpforms-26864-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-26864-field_52\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_52_1\" name=\"wpforms[fields][52]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_52_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_52_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_52_2\" name=\"wpforms[fields][52]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_52_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_52_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-field_53-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"53\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_53\">Gebruik je drugs of een overmaat aan alcohol? Specifieer aub.<\/label><textarea id=\"wpforms-26864-field_53\" class=\"wpforms-field-medium\" name=\"wpforms[fields][53]\" aria-errormessage=\"wpforms-26864-field_53-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_54-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"54\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_54\">Gebruik je op dit moment medicatie? Zo ja, wat en hoe vaak?<\/label><textarea id=\"wpforms-26864-field_54\" class=\"wpforms-field-medium\" name=\"wpforms[fields][54]\" aria-errormessage=\"wpforms-26864-field_54-error\" ><\/textarea><\/div><div id=\"wpforms-26864-field_7-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-type=\"textarea\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-26864-field_7\">Is er nog iets waarvan je wilt dat de trainer het weet?<\/label><textarea id=\"wpforms-26864-field_7\" class=\"wpforms-field-medium\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-26864-field_7-error\" ><\/textarea><\/div><div id=\"wpforms-26864-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 de mindfulness trainingen van Levensstroom leren kennen? Via folder? Zoekwoorden in Google? Met welke zoekwoorden? Advertentie van Google? Handelsgids? Gezien op Tv? Artikel in tijdschrift, krant? Ervaring van deelnemer...? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-26864-field_26\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-26864-field_26_1\" name=\"wpforms[fields][26][]\" value=\"Via verwijzing arts. Schrijf hierboven naam van de arts\" aria-errormessage=\"wpforms-26864-field_26_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-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-26864-field_26_7\" name=\"wpforms[fields][26][]\" value=\"Via vrienden of kennissen\" aria-errormessage=\"wpforms-26864-field_26_7-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_26_7\">Via vrienden of kennissen<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-26864-field_26_2\" name=\"wpforms[fields][26][]\" value=\"Via iemand die dit ook gevolgd heeft\" aria-errormessage=\"wpforms-26864-field_26_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_26_2\">Via iemand die dit ook gevolgd heeft<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-26864-field_26_3\" name=\"wpforms[fields][26][]\" value=\"Gezien op TV\" aria-errormessage=\"wpforms-26864-field_26_3-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_26_3\">Gezien op TV<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-26864-field_26_4\" name=\"wpforms[fields][26][]\" value=\"Gevonden op Google\" aria-errormessage=\"wpforms-26864-field_26_4-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_26_4\">Gevonden op Google<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-26864-field_26_5\" name=\"wpforms[fields][26][]\" value=\"Artikel in boek, tijdschrift, krant..\" aria-errormessage=\"wpforms-26864-field_26_5-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_26_5\">Artikel in boek, tijdschrift, krant..<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-26864-field_26_8\" name=\"wpforms[fields][26][]\" value=\"Andere\" aria-errormessage=\"wpforms-26864-field_26_8-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_26_8\">Andere<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-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 MBCT 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-26864-field_28\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_28_1\" name=\"wpforms[fields][28]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_28_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_28_1\">Ja<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-26864-field_28_2\" name=\"wpforms[fields][28]\" value=\"Nee\" aria-errormessage=\"wpforms-26864-field_28_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-field_28_2\">Nee<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-26864-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-26864-field_27\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-26864-field_27_1\" name=\"wpforms[fields][27][]\" value=\"Ja\" aria-errormessage=\"wpforms-26864-field_27_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-26864-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-26864-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-26864-field_2-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-26864-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=\"26864\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1791848382.36331ec2decd644c9c6261ad92081c35c7d2ade01d5c2a5ce942e906aba0261a\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/heartfulness.be\/fr\/wp-json\/wp\/v2\/pages\/27008\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-26864\" 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=\"Chargement\"><\/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 deel te nemen aan een info avond, kennismakingsavond over mindfulness, of een training? Of een heartfulness training? Dan kan je het formulier hieronder [&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-27008","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Formulaire d&#039;inscription \u00e0 la pleine conscience &#8902; Levensstroom<\/title>\n<meta name=\"description\" content=\"Ce formulaire vous permet de vous inscrire aux formations, informations et soir\u00e9es d&#039;initiation \u00e0 la pleine conscience et \u00e0 la heartfulness.\" \/>\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\/fr\/formulaire-dinscription-a-la-pleine-conscience\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Formulaire d&#039;inscription \u00e0 la pleine conscience &#8902; 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