{"id":2916,"date":"2024-07-24T20:15:03","date_gmt":"2024-07-24T18:15:03","guid":{"rendered":"https:\/\/043arts.nl\/?post_type=praktijkinformatie&#038;p=2916"},"modified":"2024-07-24T20:17:33","modified_gmt":"2024-07-24T18:17:33","slug":"4dkl","status":"publish","type":"praktijkinformatie","link":"https:\/\/huisartsenpraktijkwestertoren.nl\/en\/praktijkinformatie\/4dkl\/","title":{"rendered":"4DKL"},"content":{"rendered":"<style>.elementor-2916 .elementor-element.elementor-element-b60712e{--display:flex;--min-height:140px;--flex-direction:row;--container-widget-width:calc( ( 1 - var( --container-widget-flex-grow ) ) * 100% );--container-widget-height:100%;--container-widget-flex-grow:1;--container-widget-align-self:stretch;--flex-wrap-mobile:wrap;--justify-content:center;--align-items:center;--gap:10px 10px;--row-gap:10px;--column-gap:10px;--overlay-opacity:0.65;--padding-top:0px;--padding-bottom:0px;--padding-left:0px;--padding-right:0px;}.elementor-2916 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.elementor-element.elementor-element-b60712e:not(.elementor-motion-effects-element-type-background), .elementor-2916 .elementor-element.elementor-element-b60712e > .elementor-motion-effects-container > .elementor-motion-effects-layer{background-position:0px 0px;}.elementor-2916 .elementor-element.elementor-element-e3392da .elementor-heading-title{font-size:24px;}.elementor-2916 .elementor-element.elementor-element-b77c90d{--padding-top:20px;--padding-bottom:40px;--padding-left:25px;--padding-right:25px;}.elementor-2916 .elementor-element.elementor-element-16ca1d2{--padding-top:0px;--padding-bottom:0px;--padding-left:0px;--padding-right:0px;}.elementor-2916 .elementor-element.elementor-element-0052a78{--margin-top:20px;--margin-bottom:0px;--margin-left:0px;--margin-right:0px;--padding-top:0px;--padding-bottom:0px;--padding-left:0px;--padding-right:0px;}.elementor-2916 .elementor-element.elementor-element-54172d0 .elementor-heading-title{font-size:24px;}.elementor-2916 .elementor-element.elementor-global-2919 .jet-form-builder-progress-pages__item--wrapper.active-page .jet-form-builder-progress-pages__item{font-size:var( --e-global-typography-806d809-font-size );line-height:var( --e-global-typography-806d809-line-height );letter-spacing:var( --e-global-typography-806d809-letter-spacing );word-spacing:var( --e-global-typography-806d809-word-spacing );}}\/* Start custom CSS for global, class: .elementor-global-2919 *\/.elementor-2916 .elementor-element.elementor-global-2919 h5 {\n    margin-top: 2rem;\n    margin-bottom: 0.5rem;\n    font-weight: 800;\n}\/* End custom CSS *\/<\/style>\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"2916\" class=\"elementor elementor-2916\" data-elementor-post-type=\"praktijkinformatie\">\n\t\t\t\t<div class=\"elementor-element elementor-element-b60712e e-flex e-con-boxed e-con e-parent\" data-id=\"b60712e\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-e3392da elementor-widget elementor-widget-heading\" data-id=\"e3392da\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">4DKL<\/h1>\t\t\t\t<\/div>\n\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-b77c90d e-flex e-con-boxed e-con e-parent\" data-id=\"b77c90d\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-16ca1d2 e-con-full e-flex e-con e-child\" data-id=\"16ca1d2\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0052a78 e-con-full e-flex e-con e-child\" data-id=\"0052a78\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;jet_parallax_layout_list&quot;:[]}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-54172d0 elementor-widget elementor-widget-heading\" data-id=\"54172d0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">4DKL<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3e21d2d elementor-widget elementor-widget-text-editor\" data-id=\"3e21d2d\" 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<p>De volgende vragenlijst betreft verschillende klachten en verschijnselen die u mogelijk hebt. Het gaat steeds om klachten en verschijnselen die u de afgelopen week (de afgelopen 7 dagen met vandaag erbij) hebt ervaren. Klachten die u daarvoor wel had, maar de afgelopen week niet meer, tellen niet mee. Wilt u per klacht aangeven hoe vaak u dit in de afgelopen week bij uzelf hebt opgemerkt, door het hokje aan te kruisen dat staat voor het meest passende antwoord.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d0a0999 elementor-widget elementor-widget-global elementor-global-2919 elementor-widget-jet-form-builder-form\" data-id=\"d0a0999\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"jet-form-builder-form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<link rel='stylesheet' id='wp-block-library-css' href='https:\/\/huisartsenpraktijkwestertoren.nl\/wp-includes\/css\/dist\/block-library\/style.min.css?ver=722de48fa368c0266812110463229199' media='all' \/>\n<style id=\"jet-form-builder-2909-inline-css\"><\/style><form  class=\"jet-form-builder layout-column submit-type-ajax\" action=\"https:\/\/huisartsenpraktijkwestertoren.nl\/en\/wp-json\/wp\/v2\/praktijkinformatie\/2916\/?zNUrZY=5wxXsCsfUb&amp;method=reload\" method=\"POST\" data-form-id=\"2909\" data-layout=\"column\" enctype=\"multipart\/form-data\" data-clear=\"1\" novalidate=\"null\" ssr_validation_method=\"rest\">\r\n<input type=\"hidden\" name=\"_jfb_current_render_states[]\" value=\"DEFAULT.STATE\" data-jfb-sync \/><input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_booking_form_id\" data-field-name=\"_jet_engine_booking_form_id\" value=\"2909\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_refer\" data-field-name=\"_jet_engine_refer\" value=\"https:\/\/huisartsenpraktijkwestertoren.nl\/en\/wp-json\/wp\/v2\/praktijkinformatie\/2916\/\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"__queried_post_id\" data-field-name=\"__queried_post_id\" value=\"2916\">\n\n<input type=\"hidden\" data-dynamic-value=\"[{&quot;id&quot;:2911,&quot;conditions&quot;:[{&quot;__visible&quot;:true,&quot;field&quot;:&quot;to_email_form&quot;,&quot;operator&quot;:&quot;empty&quot;,&quot;value&quot;:&quot;&quot;}],&quot;set_on_empty&quot;:true,&quot;to_set&quot;:&quot;eldewaard@hechtcare.nl&quot;,&quot;frequency&quot;:&quot;always&quot;}]\" class=\"jet-form-builder__field hidden-field\" name=\"to_email_form\" data-field-name=\"to_email_form\" data-jfb-sync=\"null\">\n\n\n\n\n\n<div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"naam\">Achternaam <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"Achternaam\" required=\"required\" name=\"naam\" id=\"naam\" type=\"text\" data-field-name=\"naam\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_vDkHLy40\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-date-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"geboortedatum\">Geboortedatum <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><input class=\"jet-form-builder__field date-field\" required=\"required\" name=\"geboortedatum\" type=\"date\" data-field-name=\"geboortedatum\" id=\"geboortedatum\" data-jfb-sync=\"null\">\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"email\">E-mailadres <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input placeholder=\"E-mail\" required=\"required\" name=\"email\" id=\"email\" type=\"email\" data-field-name=\"email\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_iox0GSB6\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n\n<h5 class=\"wp-block-heading\">Hebt u de afgelopen week last van:<\/h5>\n\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_1\">Duizeligheid of een licht gevoel in het hoofd? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_1\" data-field-name=\"vraag_1\" id=\"vraag_1\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_2\">Last van pijnlijke spieren? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_2\" data-field-name=\"vraag_2\" id=\"vraag_2\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_3\">Flauw vallen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_3\" data-field-name=\"vraag_3\" id=\"vraag_3\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_4\">Pijn in de nek? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_4\" data-field-name=\"vraag_4\" id=\"vraag_4\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_5\">Pijn in de rug? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_5\" data-field-name=\"vraag_5\" id=\"vraag_5\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_6\">Overmatige transpiratie? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_6\" data-field-name=\"vraag_6\" id=\"vraag_6\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_7\">Hartkloppingen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_7\" data-field-name=\"vraag_7\" id=\"vraag_7\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_8\">Hoofdpijn? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_8\" data-field-name=\"vraag_8\" id=\"vraag_8\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_9\">Een opgeblazen gevoel in de buik? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_9\" data-field-name=\"vraag_9\" id=\"vraag_9\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_10\">Wazig zien of vlekken voor de ogen zien? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_10\" data-field-name=\"vraag_10\" id=\"vraag_10\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_11\">Benauwdheid? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_11\" data-field-name=\"vraag_11\" id=\"vraag_11\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_12\">Misselijkheid of een maag die \u2018van streek\u2019 is? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_12\" data-field-name=\"vraag_12\" id=\"vraag_12\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n\n<h5 class=\"wp-block-heading\">Voelt u zich de afgelopen week:<\/h5>\n\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_13\">Pijn in de buik of maagstreek? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_13\" data-field-name=\"vraag_13\" id=\"vraag_13\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_14\">Tintelingen in de vingers? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_14\" data-field-name=\"vraag_14\" id=\"vraag_14\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_15\">Een drukkend of beklemmend gevoel op de borst? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_15\" data-field-name=\"vraag_15\" id=\"vraag_15\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_16\">Pijn in de borst? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_16\" data-field-name=\"vraag_16\" id=\"vraag_16\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_17\">Neerslachtigheid? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_17\" data-field-name=\"vraag_17\" id=\"vraag_17\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_18\">Zomaar plotseling schrikken? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_18\" data-field-name=\"vraag_18\" id=\"vraag_18\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_19\">Piekeren? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_19\" data-field-name=\"vraag_19\" id=\"vraag_19\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_20\">Onrustig slapen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_20\" data-field-name=\"vraag_20\" id=\"vraag_20\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_21\">Onbestemde angstgevoelens? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_21\" data-field-name=\"vraag_21\" id=\"vraag_21\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_22\">Lusteloosheid? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_22\" data-field-name=\"vraag_22\" id=\"vraag_22\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_23\">Beven in gezelschap van andere mensen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_23\" data-field-name=\"vraag_23\" id=\"vraag_23\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_24\">Angst- of paniekaanvallen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_24\" data-field-name=\"vraag_24\" id=\"vraag_24\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_25\">Gespannen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_25\" data-field-name=\"vraag_25\" id=\"vraag_25\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_26\">Snel ge\u00efrriteerd? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_26\" data-field-name=\"vraag_26\" id=\"vraag_26\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_27\">Angstig? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_27\" data-field-name=\"vraag_27\" id=\"vraag_27\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n\n<h5 class=\"wp-block-heading\">Hebt u de afgelopen week het gevoel:<\/h5>\n\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_28\">Dat alles zinloos is? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_28\" data-field-name=\"vraag_28\" id=\"vraag_28\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_29\">Dat u tot niets meer kunt komen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_29\" data-field-name=\"vraag_29\" id=\"vraag_29\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_30\">Dat het leven niet de moeite waard is? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_30\" data-field-name=\"vraag_30\" id=\"vraag_30\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_31\">Dat u geen belangstelling meer kunt opbrengen voor de mensen en dingen om u heen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_31\" data-field-name=\"vraag_31\" id=\"vraag_31\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_32\">Dat u \u2019t niet meer aankunt? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_32\" data-field-name=\"vraag_32\" id=\"vraag_32\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_33\">Dat het beter zou zijn als u maar dood was? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_33\" data-field-name=\"vraag_33\" id=\"vraag_33\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_34\">Dat u nergens meer plezier in kunt hebben? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_34\" data-field-name=\"vraag_34\" id=\"vraag_34\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_35\">Dat er geen uitweg is uit uw situatie? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_35\" data-field-name=\"vraag_35\" id=\"vraag_35\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_36\">Dat u er niet meer tegenop kunt? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_36\" data-field-name=\"vraag_36\" id=\"vraag_36\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_37\">Dat u nergens meer zin in hebt? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_37\" data-field-name=\"vraag_37\" id=\"vraag_37\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n\n<h5 class=\"wp-block-heading\">Hebt u de afgelopen week:<\/h5>\n\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_38\">Moeite met helder denken? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_38\" data-field-name=\"vraag_38\" id=\"vraag_38\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_39\">Moeite om in slaap te komen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_39\" data-field-name=\"vraag_39\" id=\"vraag_39\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_40\">Angst om alleen het huis uit te gaan? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_40\" data-field-name=\"vraag_40\" id=\"vraag_40\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n\n<h5 class=\"wp-block-heading\">Bent u de afgelopen week:<\/h5>\n\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_41\">Snel emotioneel? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_41\" data-field-name=\"vraag_41\" id=\"vraag_41\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_42\">Angstig voor iets waarvoor u helemaal niet bang zou hoeven te zijn? (bijvoorbeeld dieren, hoogten, kleine ruimten) <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_42\" data-field-name=\"vraag_42\" id=\"vraag_42\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_43\">Bang om te reizen in bussen, treinen of trams? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_43\" data-field-name=\"vraag_43\" id=\"vraag_43\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_44\">Bang om in verlegenheid te raken in gezelschap van andere mensen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_44\" data-field-name=\"vraag_44\" id=\"vraag_44\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_45\">Hebt u weleens een gevoel of u door een onbekend gevaar bedreigd wordt? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_45\" data-field-name=\"vraag_45\" id=\"vraag_45\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_46\">Denkt u weleens 'was ik maar dood'? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_46\" data-field-name=\"vraag_46\" id=\"vraag_46\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_47\">Schieten u weleens beelden in gedachten over (een) aangrijpende gebeurtenis(sen) die u hebt meegemaakt? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_47\" data-field-name=\"vraag_47\" id=\"vraag_47\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_48\">Moet u weleens uw best doen om gedachten of herinneringen aan (een) aangrijpende gebeurtenis(sen) van u af te zetten? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_48\" data-field-name=\"vraag_48\" id=\"vraag_48\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_49\">Moet u bepaalde plaatsen vermijden omdat u er angstig van wordt? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_49\" data-field-name=\"vraag_49\" id=\"vraag_49\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<label class=\"jet-form-builder__label-text\" for=\"vraag_50\">Moet u sommige handelingen een aantal keren herhalen voordat u iets anders kunt gaan doen? <span class=\"jet-form-builder__required\">*<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"vraag_50\" data-field-name=\"vraag_50\" id=\"vraag_50\" data-jfb-sync=\"null\">\n\t\t<option value=\"\" disabled selected>Maak een keuze<\/option><option value=\"nee\"  data-calculate=\"0\">Nee<\/option><option value=\"soms\"  data-calculate=\"1\">Soms<\/option><option value=\"regelmatig\"  data-calculate=\"2\">Regelmatig<\/option><option value=\"vaak\"  data-calculate=\"2\">Vaak<\/option><option value=\"heel vaak of voortdurend\"  data-calculate=\"2\">Heel vaak of voortdurend<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n\n<div data-formula=\"%vraag_1% + %vraag_2% + %vraag_3% + %vraag_4% + %vraag_5% + %vraag_6% + %vraag_7% + %vraag_8% + %vraag_9% + %vraag_10% + %vraag_11% + %vraag_12% + %vraag_13% + %vraag_14% + %vraag_15% + %vraag_16%\" data-name=\"score_somatisatie\" data-precision=\"0\" data-sep-decimal=\".\" data-value-type=\"number\" data-date-format=\"YYYY-MM-DD\" class=\"jet-form-builder__calculated-field jet-form-builder__calculated-field--hidden\">\n\t\t\t<input type=\"hidden\"\n\t\t\tname=\"score_somatisatie\"\n\t\t\tid=\"score_somatisatie\"\n\t\t\tvalue=\"\"\n\t\t\tclass=\"jet-form-builder__calculated-field-input jet-form-builder__field\"\n\t\t\tdata-field-name=\"score_somatisatie\"\n\t\t\tdata-jfb-sync\n\t\/>\n\t<div class=\"jet-form-builder__calculated-field-val\">0.00<\/div>\n\t\t<\/div>\n\n\n\n\n<div data-formula=\"%score_somatisatie% &lt;= 10 ? &#039;Relatief normale lichamelijke spanningsklachten&#039; : (%score_somatisatie% &lt;= 20 ? &#039;Mogelijke somatisatie met dreigend disfunctioneren; bespreken met pati\u00ebnt&#039; : &#039;Grote kans op somatisatie; bespreken met pati\u00ebnt, overweeg cognitieve gedragstherapie of verwijzing&#039;)\" data-name=\"interpretatie_somatisatie\" data-precision=\"2\" data-sep-decimal=\".\" data-value-type=\"string\" data-date-format=\"YYYY-MM-DD\" class=\"jet-form-builder__calculated-field jet-form-builder__calculated-field--hidden\">\n\t\t\t<input type=\"hidden\"\n\t\t\tname=\"interpretatie_somatisatie\"\n\t\t\tid=\"interpretatie_somatisatie\"\n\t\t\tvalue=\"\"\n\t\t\tclass=\"jet-form-builder__calculated-field-input jet-form-builder__field\"\n\t\t\tdata-field-name=\"interpretatie_somatisatie\"\n\t\t\tdata-jfb-sync\n\t\/>\n\t<div class=\"jet-form-builder__calculated-field-val\">0.00<\/div>\n\t\t<\/div>\n\n\n\n\n<div data-formula=\"%vraag_18% + %vraag_21% + %vraag_23% + %vraag_24% + %vraag_27% + %vraag_40% + %vraag_42% + %vraag_43% + %vraag_44% + %vraag_45% + %vraag_49% + %vraag_50%\" data-name=\"score_angst\" data-precision=\"0\" data-sep-decimal=\".\" data-value-type=\"number\" data-date-format=\"YYYY-MM-DD\" class=\"jet-form-builder__calculated-field jet-form-builder__calculated-field--hidden\">\n\t\t\t<input type=\"hidden\"\n\t\t\tname=\"score_angst\"\n\t\t\tid=\"score_angst\"\n\t\t\tvalue=\"\"\n\t\t\tclass=\"jet-form-builder__calculated-field-input jet-form-builder__field\"\n\t\t\tdata-field-name=\"score_angst\"\n\t\t\tdata-jfb-sync\n\t\/>\n\t<div class=\"jet-form-builder__calculated-field-val\">0.00<\/div>\n\t\t<\/div>\n\n\n\n\n<div data-formula=\"%score_angst% &lt;= 3 ? &#039;Waarschijnlijk geen angststoornis&#039; : (%score_angst% &lt;= 9 ? &#039;Mogelijke angststoornis; aanzien en na enkele weken herevalueren; eventueel diagnostiek van angststoornissen&#039; : &#039;Relatief grote kans op \u00e9\u00e9n of meer angststoornissen; diagnostiek van angststoornissen is aangewezen&#039;)\" data-name=\"interpretatie_angst\" data-precision=\"2\" data-sep-decimal=\".\" data-value-type=\"string\" data-date-format=\"YYYY-MM-DD\" class=\"jet-form-builder__calculated-field jet-form-builder__calculated-field--hidden\">\n\t\t\t<input type=\"hidden\"\n\t\t\tname=\"interpretatie_angst\"\n\t\t\tid=\"interpretatie_angst\"\n\t\t\tvalue=\"\"\n\t\t\tclass=\"jet-form-builder__calculated-field-input jet-form-builder__field\"\n\t\t\tdata-field-name=\"interpretatie_angst\"\n\t\t\tdata-jfb-sync\n\t\/>\n\t<div class=\"jet-form-builder__calculated-field-val\">0.00<\/div>\n\t\t<\/div>\n\n\n\n\n<div data-formula=\"%vraag_28% + %vraag_30% + %vraag_33% + %vraag_34% + %vraag_35% + %vraag_46%\" data-name=\"score_depressie\" data-precision=\"0\" data-sep-decimal=\".\" data-value-type=\"number\" data-date-format=\"YYYY-MM-DD\" class=\"jet-form-builder__calculated-field jet-form-builder__calculated-field--hidden\">\n\t\t\t<input type=\"hidden\"\n\t\t\tname=\"score_depressie\"\n\t\t\tid=\"score_depressie\"\n\t\t\tvalue=\"\"\n\t\t\tclass=\"jet-form-builder__calculated-field-input jet-form-builder__field\"\n\t\t\tdata-field-name=\"score_depressie\"\n\t\t\tdata-jfb-sync\n\t\/>\n\t<div class=\"jet-form-builder__calculated-field-val\">0.00<\/div>\n\t\t<\/div>\n\n\n\n\n<div data-formula=\"%score_depressie% &lt;= 2 ? 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