{"id":52,"date":"2024-12-21T19:44:00","date_gmt":"2024-12-21T19:44:00","guid":{"rendered":"https:\/\/justine.informatica.gsf.nl\/?page_id=52"},"modified":"2025-04-06T07:59:56","modified_gmt":"2025-04-06T07:59:56","slug":"uw-medische-gegevens","status":"publish","type":"page","link":"https:\/\/justine.informatica.gsf.nl\/?page_id=52","title":{"rendered":"Start met de vragenlijst"},"content":{"rendered":"<div class=\"forminator-ui forminator-custom-form forminator-custom-form-420 forminator-design--default  forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-420\" data-uid=\"6a28b99e7b470\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-420\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-420 forminator-design--default  forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"420\"\n\t\t\t\t\n\t\t\t\tdata-design=\"default\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tdata-grid=\"open\"\n\t\t\t\t\n\t\t\t\t\n\t\t\t\tstyle=\"display: none;\"\n\t\t\t\t\n\t\t\t\tdata-uid=\"6a28b99e7b470\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div role=\"tablist\" class=\"forminator-pagination-steps\" aria-label=\"Pagination\"><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-420--page-0\" class=\"forminator-pagination forminator-pagination-start\" aria-labelledby=\"forminator-custom-form-420--page-0-label\" data-step=\"0\" data-label=\"Volgende\" data-name=\"page-break-1\"><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"number-1\" class=\"forminator-field-number forminator-col forminator-col-12 \"><div class=\"forminator-field\"><label for=\"forminator-field-number-1_6a28b99e7b470\" id=\"forminator-field-number-1_6a28b99e7b470-label\" class=\"forminator-label\">Leeftijd <span class=\"forminator-required\">*<\/span><\/label><input name=\"number-1\" value=\"\" placeholder=\"\" id=\"forminator-field-number-1_6a28b99e7b470\" class=\"forminator-input forminator-number--field\" inputmode=\"decimal\" data-required=\"1\" data-decimals=\"0\" aria-required=\"true\" data-inputmask=\"&#039;groupSeparator&#039;: &#039;&#039;, &#039;radixPoint&#039;: &#039;&#039;, &#039;digits&#039;: &#039;0&#039;\" data-hidden-behavior=\"zero\" type=\"number\" step=\"any\" min=\"1\" max=\"120\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"radio-1\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6a28b99e7b470-label\"><span id=\"forminator-radiogroup-6a28b99e7b470-label\" class=\"forminator-label\">Geboortegeslacht <span class=\"forminator-required\">*<\/span><\/span><label id=\"forminator-field-radio-1-label-1\" for=\"forminator-field-radio-1-1-6a28b99e7b470\" class=\"forminator-radio\" title=\"Man\"><input type=\"radio\" name=\"radio-1\" value=\"one\" id=\"forminator-field-radio-1-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-1-label-1\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Man<\/span><\/label><label id=\"forminator-field-radio-1-label-2\" for=\"forminator-field-radio-1-2-6a28b99e7b470\" class=\"forminator-radio\" title=\"Vrouw\"><input type=\"radio\" name=\"radio-1\" value=\"two\" id=\"forminator-field-radio-1-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-1-label-2\" data-calculation=\"0\"  \/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Vrouw<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-1\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Relevante medische voorgeschiedenis<\/span><label id=\"forminator-field-checkbox-1-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Ik ben op dit moment zwanger\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Ik-ben-op-dit-moment-zwanger\" id=\"forminator-field-checkbox-1-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ik ben op dit moment zwanger<\/span><\/label><label id=\"forminator-field-checkbox-1-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Astma\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"one\" id=\"forminator-field-checkbox-1-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Astma<\/span><\/label><label id=\"forminator-field-checkbox-1-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Slechtziendheid\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Slechtziendheid\" id=\"forminator-field-checkbox-1-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Slechtziendheid<\/span><\/label><label id=\"forminator-field-checkbox-1-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Obesitas\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"two\" id=\"forminator-field-checkbox-1-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Obesitas<\/span><\/label><label id=\"forminator-field-checkbox-1-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Reuma\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Reuma\" id=\"forminator-field-checkbox-1-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Reuma<\/span><\/label><label id=\"forminator-field-checkbox-1-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hart- en vaatziekte\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Hart--en-vaatziekte\" id=\"forminator-field-checkbox-1-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hart- en vaatziekte<\/span><\/label><label id=\"forminator-field-checkbox-1-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Roken\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Roken\" id=\"forminator-field-checkbox-1-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Roken<\/span><\/label><label id=\"forminator-field-checkbox-1-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overmatig alcoholgebruik\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Overmatig-alcoholgebruik\" id=\"forminator-field-checkbox-1-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overmatig alcoholgebruik<\/span><\/label><label id=\"forminator-field-checkbox-1-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"COPD\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"COPD\" id=\"forminator-field-checkbox-1-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">COPD<\/span><\/label><label id=\"forminator-field-checkbox-1-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Drugsgebruik\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Drugsgebruik\" id=\"forminator-field-checkbox-1-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Drugsgebruik<\/span><\/label><label id=\"forminator-field-checkbox-1-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-1-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Diabetes\"><input type=\"checkbox\" name=\"checkbox-1[]\" value=\"Diabetes\" id=\"forminator-field-checkbox-1-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-1-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Diabetes<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-420--page-1\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-420--page-1-label\" aria-hidden=\"true\" data-step=\"1\" data-label=\"Persoonsgegevens\" data-name=\"page-break-2\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"checkbox-2\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Waar ervaart u klachten? (benoem alles)<\/span><label id=\"forminator-field-checkbox-2-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hoofd\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"one\" id=\"forminator-field-checkbox-2-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hoofd<\/span><\/label><label id=\"forminator-field-checkbox-2-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Ogen\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Ogen\" id=\"forminator-field-checkbox-2-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ogen<\/span><\/label><label id=\"forminator-field-checkbox-2-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Oren\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Oren\" id=\"forminator-field-checkbox-2-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Oren<\/span><\/label><label id=\"forminator-field-checkbox-2-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Nek of keel\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"two\" id=\"forminator-field-checkbox-2-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Nek of keel<\/span><\/label><label id=\"forminator-field-checkbox-2-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Borst\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Borst\" id=\"forminator-field-checkbox-2-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Borst<\/span><\/label><label id=\"forminator-field-checkbox-2-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Buik\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Buik\" id=\"forminator-field-checkbox-2-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Buik<\/span><\/label><label id=\"forminator-field-checkbox-2-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Rug\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Rug\" id=\"forminator-field-checkbox-2-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rug<\/span><\/label><label id=\"forminator-field-checkbox-2-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Armen of handen\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Armen-of-handen\" id=\"forminator-field-checkbox-2-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Armen of handen<\/span><\/label><label id=\"forminator-field-checkbox-2-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Benen of voeten\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Benen-of-voeten\" id=\"forminator-field-checkbox-2-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Benen of voeten<\/span><\/label><label id=\"forminator-field-checkbox-2-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Huid\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Huid\" id=\"forminator-field-checkbox-2-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Huid<\/span><\/label><label id=\"forminator-field-checkbox-2-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Ontlasting\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Geslacht\" id=\"forminator-field-checkbox-2-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ontlasting<\/span><\/label><label id=\"forminator-field-checkbox-2-12-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-12-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hele lichaam\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Hele-lichaam\" id=\"forminator-field-checkbox-2-12-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-12-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hele lichaam<\/span><\/label><label id=\"forminator-field-checkbox-2-13-6a28b99e7b470-label\" for=\"forminator-field-checkbox-2-13-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Psychische klachten\"><input type=\"checkbox\" name=\"checkbox-2[]\" value=\"Psychische-klachten\" id=\"forminator-field-checkbox-2-13-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-2-13-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Psychische klachten<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-420--page-2\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-420--page-2-label\" aria-hidden=\"true\" data-step=\"2\" data-label=\"Pagina  2\" data-name=\"page-break-3\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"checkbox-3\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw hoofd? (benoem alles)<\/span><label id=\"forminator-field-checkbox-3-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hoofdpijn\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"one\" id=\"forminator-field-checkbox-3-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hoofdpijn<\/span><\/label><label id=\"forminator-field-checkbox-3-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Koorts\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"two\" id=\"forminator-field-checkbox-3-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Koorts<\/span><\/label><label id=\"forminator-field-checkbox-3-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Duizeligheid\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Duizeligheid\" id=\"forminator-field-checkbox-3-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Duizeligheid<\/span><\/label><label id=\"forminator-field-checkbox-3-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verlamdheid\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Verlamdheid\" id=\"forminator-field-checkbox-3-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verlamdheid<\/span><\/label><label id=\"forminator-field-checkbox-3-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Bewustzijnsverlies\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Bewustzijnsverlies\" id=\"forminator-field-checkbox-3-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bewustzijnsverlies<\/span><\/label><label id=\"forminator-field-checkbox-3-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Co\u00f6rdinatieproblemen\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Co\u00f6rdinatieproblemen\" id=\"forminator-field-checkbox-3-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Co\u00f6rdinatieproblemen<\/span><\/label><label id=\"forminator-field-checkbox-3-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Scheve mond\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Scheve-mond\" id=\"forminator-field-checkbox-3-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Scheve mond<\/span><\/label><label id=\"forminator-field-checkbox-3-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Flauwvallen\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Flauwvallen\" id=\"forminator-field-checkbox-3-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Flauwvallen<\/span><\/label><label id=\"forminator-field-checkbox-3-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Haaruitval\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Haaruitval\" id=\"forminator-field-checkbox-3-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Haaruitval<\/span><\/label><label id=\"forminator-field-checkbox-3-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-3-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Loopneus\"><input type=\"checkbox\" name=\"checkbox-3[]\" value=\"Loopneus\" id=\"forminator-field-checkbox-3-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-3-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Loopneus<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-4\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw nek of keel? (benoem alles)<\/span><label id=\"forminator-field-checkbox-4-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Benauwdheid\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Benauwdheid\" id=\"forminator-field-checkbox-4-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Benauwdheid<\/span><\/label><label id=\"forminator-field-checkbox-4-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Boeren\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"two\" id=\"forminator-field-checkbox-4-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Boeren<\/span><\/label><label id=\"forminator-field-checkbox-4-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Brandend maagzuur\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Brandend-maagzuur\" id=\"forminator-field-checkbox-4-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Brandend maagzuur<\/span><\/label><label id=\"forminator-field-checkbox-4-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hoesten\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Hoesten\" id=\"forminator-field-checkbox-4-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hoesten<\/span><\/label><label id=\"forminator-field-checkbox-4-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Keelpijn\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Keelpijn\" id=\"forminator-field-checkbox-4-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Keelpijn<\/span><\/label><label id=\"forminator-field-checkbox-4-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Kortademigheid\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Kortademigheid\" id=\"forminator-field-checkbox-4-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Kortademigheid<\/span><\/label><label id=\"forminator-field-checkbox-4-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Ophoesten van slijm\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Ophoesten-van-slijm\" id=\"forminator-field-checkbox-4-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ophoesten van slijm<\/span><\/label><label id=\"forminator-field-checkbox-4-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overgeven\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Overgeven\" id=\"forminator-field-checkbox-4-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overgeven<\/span><\/label><label id=\"forminator-field-checkbox-4-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overmatige dorst\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Overmatige-dorst\" id=\"forminator-field-checkbox-4-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overmatige dorst<\/span><\/label><label id=\"forminator-field-checkbox-4-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Piepende ademhaling\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Piepende-ademhaling\" id=\"forminator-field-checkbox-4-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Piepende ademhaling<\/span><\/label><label id=\"forminator-field-checkbox-4-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Stijve nek\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Stijve-nek\" id=\"forminator-field-checkbox-4-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Stijve nek<\/span><\/label><label id=\"forminator-field-checkbox-4-12-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-12-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verlamming\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Verlamming\" id=\"forminator-field-checkbox-4-12-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-12-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verlamming<\/span><\/label><label id=\"forminator-field-checkbox-4-13-6a28b99e7b470-label\" for=\"forminator-field-checkbox-4-13-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Zwelling\"><input type=\"checkbox\" name=\"checkbox-4[]\" value=\"Zwelling\" id=\"forminator-field-checkbox-4-13-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-4-13-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Zwelling<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-5\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw rug? (benoem alles)<\/span><label id=\"forminator-field-checkbox-5-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-5-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierpijn\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"one\" id=\"forminator-field-checkbox-5-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-5-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierpijn<\/span><\/label><label id=\"forminator-field-checkbox-5-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-5-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Stijve spieren\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"two\" id=\"forminator-field-checkbox-5-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-5-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Stijve spieren<\/span><\/label><label id=\"forminator-field-checkbox-5-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-5-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierkrampen\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Spierkramp\" id=\"forminator-field-checkbox-5-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-5-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierkrampen<\/span><\/label><label id=\"forminator-field-checkbox-5-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-5-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierspanning\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Spierspanning\" id=\"forminator-field-checkbox-5-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-5-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierspanning<\/span><\/label><label id=\"forminator-field-checkbox-5-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-5-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierzwakte\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Spierzwakte\" id=\"forminator-field-checkbox-5-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-5-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierzwakte<\/span><\/label><label id=\"forminator-field-checkbox-5-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-5-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verlamming\"><input type=\"checkbox\" name=\"checkbox-5[]\" value=\"Verlamming\" id=\"forminator-field-checkbox-5-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-5-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verlamming<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-7\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw buik? (benoem alles)<\/span><label id=\"forminator-field-checkbox-7-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Boeren\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"one\" id=\"forminator-field-checkbox-7-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Boeren<\/span><\/label><label id=\"forminator-field-checkbox-7-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Brandend maagzuur\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"two\" id=\"forminator-field-checkbox-7-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Brandend maagzuur<\/span><\/label><label id=\"forminator-field-checkbox-7-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Buikpijn\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Buikpijn\" id=\"forminator-field-checkbox-7-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Buikpijn<\/span><\/label><label id=\"forminator-field-checkbox-7-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Constipatie\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Constipatie\" id=\"forminator-field-checkbox-7-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Constipatie<\/span><\/label><label id=\"forminator-field-checkbox-7-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Diarree\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Diarree\" id=\"forminator-field-checkbox-7-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Diarree<\/span><\/label><label id=\"forminator-field-checkbox-7-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Donkere of zwarte ontlasting\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Donkere-of-zwarte-ontlasting\" id=\"forminator-field-checkbox-7-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Donkere of zwarte ontlasting<\/span><\/label><label id=\"forminator-field-checkbox-7-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Misselijkheid\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Misselijkheid\" id=\"forminator-field-checkbox-7-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Misselijkheid<\/span><\/label><label id=\"forminator-field-checkbox-7-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Obstipatie\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Obstipatie\" id=\"forminator-field-checkbox-7-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Obstipatie<\/span><\/label><label id=\"forminator-field-checkbox-7-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Opgeblazen gevoel\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Opgeblazen-gevoel\" id=\"forminator-field-checkbox-7-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Opgeblazen gevoel<\/span><\/label><label id=\"forminator-field-checkbox-7-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overgeven\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Overgeven\" id=\"forminator-field-checkbox-7-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overgeven<\/span><\/label><label id=\"forminator-field-checkbox-7-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-7-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verminderde eetlust\"><input type=\"checkbox\" name=\"checkbox-7[]\" value=\"Verminderde-eetlust\" id=\"forminator-field-checkbox-7-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-7-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verminderde eetlust<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-8\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke psychische klachten ervaart u? (benoem alles)<\/span><label id=\"forminator-field-checkbox-8-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Angstgevoelens\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"one\" id=\"forminator-field-checkbox-8-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Angstgevoelens<\/span><\/label><label id=\"forminator-field-checkbox-8-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Bewustzijnsverlies\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"two\" id=\"forminator-field-checkbox-8-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bewustzijnsverlies<\/span><\/label><label id=\"forminator-field-checkbox-8-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Concentratieproblemen\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Concentratieproblemen\" id=\"forminator-field-checkbox-8-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Concentratieproblemen<\/span><\/label><label id=\"forminator-field-checkbox-8-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Emotionele instabiliteit\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Emotionele-instabiliteit\" id=\"forminator-field-checkbox-8-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Emotionele instabiliteit<\/span><\/label><label id=\"forminator-field-checkbox-8-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Geheugenproblemen\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Geheugenproblemen\" id=\"forminator-field-checkbox-8-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Geheugenproblemen<\/span><\/label><label id=\"forminator-field-checkbox-8-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hallucinaties\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Hallucinaties\" id=\"forminator-field-checkbox-8-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hallucinaties<\/span><\/label><label id=\"forminator-field-checkbox-8-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hyperactiviteit\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Hyperactiviteit\" id=\"forminator-field-checkbox-8-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hyperactiviteit<\/span><\/label><label id=\"forminator-field-checkbox-8-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Lusteloosheid\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Lusteloosheid\" id=\"forminator-field-checkbox-8-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Lusteloosheid<\/span><\/label><label id=\"forminator-field-checkbox-8-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overgevoeligheid voor geuren\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Overgevoeligheid-voor-geuren\" id=\"forminator-field-checkbox-8-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overgevoeligheid voor geuren<\/span><\/label><label id=\"forminator-field-checkbox-8-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overgevoeligheid voor geluid\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Overgevoeligheid-voor-geluid\" id=\"forminator-field-checkbox-8-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overgevoeligheid voor geluid<\/span><\/label><label id=\"forminator-field-checkbox-8-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overgevoeligheid voor licht\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Overgevoeligheid-voor-licht\" id=\"forminator-field-checkbox-8-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overgevoeligheid voor licht<\/span><\/label><label id=\"forminator-field-checkbox-8-12-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-12-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Paniekaanvallen\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Paniekaanvallen\" id=\"forminator-field-checkbox-8-12-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-12-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Paniekaanvallen<\/span><\/label><label id=\"forminator-field-checkbox-8-13-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-13-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Slaapproblemen\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Slaapproblemen\" id=\"forminator-field-checkbox-8-13-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-13-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Slaapproblemen<\/span><\/label><label id=\"forminator-field-checkbox-8-14-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-14-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Somberheid\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Somberheid\" id=\"forminator-field-checkbox-8-14-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-14-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Somberheid<\/span><\/label><label id=\"forminator-field-checkbox-8-15-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-15-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Stemmingswisselingen\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Stemmingswisselingen\" id=\"forminator-field-checkbox-8-15-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-15-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Stemmingswisselingen<\/span><\/label><label id=\"forminator-field-checkbox-8-16-6a28b99e7b470-label\" for=\"forminator-field-checkbox-8-16-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Vermoeidheid\"><input type=\"checkbox\" name=\"checkbox-8[]\" value=\"Vermoeidheid\" id=\"forminator-field-checkbox-8-16-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-8-16-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Vermoeidheid<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-9\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw hele lichaam? (benoem alles)<\/span><label id=\"forminator-field-checkbox-9-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Bewegingsbeperking\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"one\" id=\"forminator-field-checkbox-9-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Bewegingsbeperking<\/span><\/label><label id=\"forminator-field-checkbox-9-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Evenwichtsproblemen\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"two\" id=\"forminator-field-checkbox-9-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Evenwichtsproblemen<\/span><\/label><label id=\"forminator-field-checkbox-9-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Flauwvallen\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Flauwvallen\" id=\"forminator-field-checkbox-9-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Flauwvallen<\/span><\/label><label id=\"forminator-field-checkbox-9-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Gevoelloosheid of trillingen\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Gevoelloosheid-of-trillingen\" id=\"forminator-field-checkbox-9-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Gevoelloosheid of trillingen<\/span><\/label><label id=\"forminator-field-checkbox-9-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hyperactiviteit\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Hyperactiviteit\" id=\"forminator-field-checkbox-9-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hyperactiviteit<\/span><\/label><label id=\"forminator-field-checkbox-9-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Jeuk\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Jeuk\" id=\"forminator-field-checkbox-9-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Jeuk<\/span><\/label><label id=\"forminator-field-checkbox-9-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Koude intolerantie\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Koude-intolerantie\" id=\"forminator-field-checkbox-9-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Koude intolerantie<\/span><\/label><label id=\"forminator-field-checkbox-9-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Koude rillingen\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Koude-rillingen\" id=\"forminator-field-checkbox-9-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Koude rillingen<\/span><\/label><label id=\"forminator-field-checkbox-9-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Onverklaarbaar gewichtsverlies\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Onverklaarbaar-gewichtsverlies\" id=\"forminator-field-checkbox-9-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Onverklaarbaar gewichtsverlies<\/span><\/label><label id=\"forminator-field-checkbox-9-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Onverklaarbare gewichtstoename\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Onverklaarbare-gewichtstoename\" id=\"forminator-field-checkbox-9-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Onverklaarbare gewichtstoename<\/span><\/label><label id=\"forminator-field-checkbox-9-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Onwillekeurige bewegingen\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Onwillekeurige-bewegingen\" id=\"forminator-field-checkbox-9-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Onwillekeurige bewegingen<\/span><\/label><label id=\"forminator-field-checkbox-9-12-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-12-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overmatige dorst\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Overmatige-dorst\" id=\"forminator-field-checkbox-9-12-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-12-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overmatige dorst<\/span><\/label><label id=\"forminator-field-checkbox-9-13-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-13-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Pijnlijke gewrichten\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Pijnlijke-gewrichten\" id=\"forminator-field-checkbox-9-13-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-13-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Pijnlijke gewrichten<\/span><\/label><label id=\"forminator-field-checkbox-9-14-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-14-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Pijnlijke spieren\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Pijnlijke-spieren\" id=\"forminator-field-checkbox-9-14-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-14-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Pijnlijke spieren<\/span><\/label><label id=\"forminator-field-checkbox-9-15-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-15-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Rillingen\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Rillingen\" id=\"forminator-field-checkbox-9-15-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-15-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rillingen<\/span><\/label><label id=\"forminator-field-checkbox-9-16-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-16-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierkrampen\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Spierkrampen\" id=\"forminator-field-checkbox-9-16-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-16-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierkrampen<\/span><\/label><label id=\"forminator-field-checkbox-9-17-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-17-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierpijn\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Spierpijn\" id=\"forminator-field-checkbox-9-17-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-17-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierpijn<\/span><\/label><label id=\"forminator-field-checkbox-9-18-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-18-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierschokken\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Spierschokken\" id=\"forminator-field-checkbox-9-18-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-18-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierschokken<\/span><\/label><label id=\"forminator-field-checkbox-9-19-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-19-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierspanning\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Spierspanning\" id=\"forminator-field-checkbox-9-19-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-19-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierspanning<\/span><\/label><label id=\"forminator-field-checkbox-9-20-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-20-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierzwakte\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Spierzwakte\" id=\"forminator-field-checkbox-9-20-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-20-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierzwakte<\/span><\/label><label id=\"forminator-field-checkbox-9-21-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-21-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Stijfheid in gewrichten\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Stijfheid-in-gewrichten\" id=\"forminator-field-checkbox-9-21-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-21-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Stijfheid in gewrichten<\/span><\/label><label id=\"forminator-field-checkbox-9-22-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-22-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Stijve spieren\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Stijve-spieren\" id=\"forminator-field-checkbox-9-22-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-22-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Stijve spieren<\/span><\/label><label id=\"forminator-field-checkbox-9-23-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-23-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verlamming\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Verlammings\" id=\"forminator-field-checkbox-9-23-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-23-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verlamming<\/span><\/label><label id=\"forminator-field-checkbox-9-24-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-24-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verminderde eetlust\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Verminderde-eetlust\" id=\"forminator-field-checkbox-9-24-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-24-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verminderde eetlust<\/span><\/label><label id=\"forminator-field-checkbox-9-25-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-25-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Vermoeidheid\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Vermoeidheid\" id=\"forminator-field-checkbox-9-25-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-25-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Vermoeidheid<\/span><\/label><label id=\"forminator-field-checkbox-9-26-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-26-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Warmte\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Warmte\" id=\"forminator-field-checkbox-9-26-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-26-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Warmte<\/span><\/label><label id=\"forminator-field-checkbox-9-27-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-27-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Warmte-intolerantie\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Warmte-intolerantie\" id=\"forminator-field-checkbox-9-27-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-27-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Warmte-intolerantie<\/span><\/label><label id=\"forminator-field-checkbox-9-28-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-28-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Wijdverspreide pijn\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Wijdverspreide-pijn\" id=\"forminator-field-checkbox-9-28-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-28-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Wijdverspreide pijn<\/span><\/label><label id=\"forminator-field-checkbox-9-29-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-29-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Zwelling\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Zwelling\" id=\"forminator-field-checkbox-9-29-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-29-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Zwelling<\/span><\/label><label id=\"forminator-field-checkbox-9-30-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-30-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Zweten\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Zweten\" id=\"forminator-field-checkbox-9-30-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-30-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Zweten<\/span><\/label><label id=\"forminator-field-checkbox-9-31-6a28b99e7b470-label\" for=\"forminator-field-checkbox-9-31-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Koorts\"><input type=\"checkbox\" name=\"checkbox-9[]\" value=\"Koorts\" id=\"forminator-field-checkbox-9-31-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-9-31-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Koorts<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-10\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw benen of voeten? (benoem alles)<\/span><label id=\"forminator-field-checkbox-10-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Koude voeten\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"one\" id=\"forminator-field-checkbox-10-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Koude voeten<\/span><\/label><label id=\"forminator-field-checkbox-10-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Langzame bewegingen\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"two\" id=\"forminator-field-checkbox-10-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Langzame bewegingen<\/span><\/label><label id=\"forminator-field-checkbox-10-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Opgezette benen of enkels\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Opgezette-benen-of-enkels\" id=\"forminator-field-checkbox-10-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Opgezette benen of enkels<\/span><\/label><label id=\"forminator-field-checkbox-10-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierkrampen\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Spierkrampen\" id=\"forminator-field-checkbox-10-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierkrampen<\/span><\/label><label id=\"forminator-field-checkbox-10-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierpijn\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Spierschokken\" id=\"forminator-field-checkbox-10-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierpijn<\/span><\/label><label id=\"forminator-field-checkbox-10-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierschokken\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Spierschokken\" id=\"forminator-field-checkbox-10-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierschokken<\/span><\/label><label id=\"forminator-field-checkbox-10-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierspanning\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Spierspanning\" id=\"forminator-field-checkbox-10-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierspanning<\/span><\/label><label id=\"forminator-field-checkbox-10-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierzwakte\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Spierzwakte\" id=\"forminator-field-checkbox-10-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierzwakte<\/span><\/label><label id=\"forminator-field-checkbox-10-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Stijfheid in de gewrichten\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Stijfheid-in-de-gewrichten\" id=\"forminator-field-checkbox-10-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Stijfheid in de gewrichten<\/span><\/label><label id=\"forminator-field-checkbox-10-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Trillen\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Trillen\" id=\"forminator-field-checkbox-10-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Trillen<\/span><\/label><label id=\"forminator-field-checkbox-10-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verdikte nagels\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Verdikte-nagels\" id=\"forminator-field-checkbox-10-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verdikte nagels<\/span><\/label><label id=\"forminator-field-checkbox-10-12-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-12-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verkleurde nagels\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Verkleurde-nagels\" id=\"forminator-field-checkbox-10-12-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-12-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verkleurde nagels<\/span><\/label><label id=\"forminator-field-checkbox-10-13-6a28b99e7b470-label\" for=\"forminator-field-checkbox-10-13-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verlamming\"><input type=\"checkbox\" name=\"checkbox-10[]\" value=\"Verlamming\" id=\"forminator-field-checkbox-10-13-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-10-13-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verlamming<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-11\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw ogen? (benoem alles)<\/span><label id=\"forminator-field-checkbox-11-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Droge ogen\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"one\" id=\"forminator-field-checkbox-11-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Droge ogen<\/span><\/label><label id=\"forminator-field-checkbox-11-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Dubbelzien\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"two\" id=\"forminator-field-checkbox-11-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Dubbelzien<\/span><\/label><label id=\"forminator-field-checkbox-11-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Duizeligheid\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Duizeligheid\" id=\"forminator-field-checkbox-11-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Duizeligheid<\/span><\/label><label id=\"forminator-field-checkbox-11-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Jeuk\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Jeuk\" id=\"forminator-field-checkbox-11-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Jeuk<\/span><\/label><label id=\"forminator-field-checkbox-11-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overgevoeligheid voor licht\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Overgevoeligheid-voor-licht\" id=\"forminator-field-checkbox-11-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overgevoeligheid voor licht<\/span><\/label><label id=\"forminator-field-checkbox-11-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Pijnlijke ogen\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Pijnlijke-ogen\" id=\"forminator-field-checkbox-11-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Pijnlijke ogen<\/span><\/label><label id=\"forminator-field-checkbox-11-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Rode ogen\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Rode-ogen\" id=\"forminator-field-checkbox-11-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Rode ogen<\/span><\/label><label id=\"forminator-field-checkbox-11-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Slecht zien\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Slecht-zien\" id=\"forminator-field-checkbox-11-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Slecht zien<\/span><\/label><label id=\"forminator-field-checkbox-11-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Tranende ogen\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Tranende-ogen\" id=\"forminator-field-checkbox-11-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Tranende ogen<\/span><\/label><label id=\"forminator-field-checkbox-11-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verminderd zicht\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Verminderd-zicht\" id=\"forminator-field-checkbox-11-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verminderd zicht<\/span><\/label><label id=\"forminator-field-checkbox-11-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-11-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Wazig zicht\"><input type=\"checkbox\" name=\"checkbox-11[]\" value=\"Wazig-heid\" id=\"forminator-field-checkbox-11-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-11-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Wazig zicht<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-13\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw borst? (benoem alles)<\/span><label id=\"forminator-field-checkbox-13-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Benauwdheid\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"one\" id=\"forminator-field-checkbox-13-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Benauwdheid<\/span><\/label><label id=\"forminator-field-checkbox-13-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Boeren\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"two\" id=\"forminator-field-checkbox-13-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Boeren<\/span><\/label><label id=\"forminator-field-checkbox-13-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Brandend maagzuur\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Brandend-maagzuur\" id=\"forminator-field-checkbox-13-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Brandend maagzuur<\/span><\/label><label id=\"forminator-field-checkbox-13-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hartkloppingen\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Hartkloppingen\" id=\"forminator-field-checkbox-13-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hartkloppingen<\/span><\/label><label id=\"forminator-field-checkbox-13-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Hoesten\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Hoesten\" id=\"forminator-field-checkbox-13-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Hoesten<\/span><\/label><label id=\"forminator-field-checkbox-13-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Kortademigheid\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Kortademigheid\" id=\"forminator-field-checkbox-13-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Kortademigheid<\/span><\/label><label id=\"forminator-field-checkbox-13-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Misselijkheid\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Misselijkheid\" id=\"forminator-field-checkbox-13-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Misselijkheid<\/span><\/label><label id=\"forminator-field-checkbox-13-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Ophoesten van slijm\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Ophoesten-van-slijm\" id=\"forminator-field-checkbox-13-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Ophoesten van slijm<\/span><\/label><label id=\"forminator-field-checkbox-13-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Overgeven\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Overgeven\" id=\"forminator-field-checkbox-13-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Overgeven<\/span><\/label><label id=\"forminator-field-checkbox-13-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Piepende ademhaling\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Piepende-ademhaling\" id=\"forminator-field-checkbox-13-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Piepende ademhaling<\/span><\/label><label id=\"forminator-field-checkbox-13-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Pijn op de borst\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Pijn-op-de-borst\" id=\"forminator-field-checkbox-13-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Pijn op de borst<\/span><\/label><label id=\"forminator-field-checkbox-13-12-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-12-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Pijn op de borst bij ademen\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Pijn-op-de-borst-bij-ademen\" id=\"forminator-field-checkbox-13-12-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-12-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Pijn op de borst bij ademen<\/span><\/label><label id=\"forminator-field-checkbox-13-13-6a28b99e7b470-label\" for=\"forminator-field-checkbox-13-13-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Snelle hartslag\"><input type=\"checkbox\" name=\"checkbox-13[]\" value=\"Snelle-hartslag\" id=\"forminator-field-checkbox-13-13-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-13-13-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Snelle hartslag<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-14\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw armen of handen? (benoem alles)<\/span><label id=\"forminator-field-checkbox-14-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Koude handen\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"one\" id=\"forminator-field-checkbox-14-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Koude handen<\/span><\/label><label id=\"forminator-field-checkbox-14-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierkrampen\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"two\" id=\"forminator-field-checkbox-14-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierkrampen<\/span><\/label><label id=\"forminator-field-checkbox-14-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierpijn\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Spierpijn\" id=\"forminator-field-checkbox-14-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierpijn<\/span><\/label><label id=\"forminator-field-checkbox-14-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierschokken\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Spierschokken\" id=\"forminator-field-checkbox-14-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierschokken<\/span><\/label><label id=\"forminator-field-checkbox-14-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierspanning\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Spierspanning\" id=\"forminator-field-checkbox-14-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierspanning<\/span><\/label><label id=\"forminator-field-checkbox-14-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Spierzwakte\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Spierzwakte\" id=\"forminator-field-checkbox-14-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Spierzwakte<\/span><\/label><label id=\"forminator-field-checkbox-14-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Stijfheid in de gewrichten\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Stijfheid-in-de-gewrichten\" id=\"forminator-field-checkbox-14-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Stijfheid in de gewrichten<\/span><\/label><label id=\"forminator-field-checkbox-14-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Trillen\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Trillen\" id=\"forminator-field-checkbox-14-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Trillen<\/span><\/label><label id=\"forminator-field-checkbox-14-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verdikte nagels\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Verdikte-nagels\" id=\"forminator-field-checkbox-14-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verdikte nagels<\/span><\/label><label id=\"forminator-field-checkbox-14-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verkleurde nagels\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Verkleurde-nagels\" id=\"forminator-field-checkbox-14-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verkleurde nagels<\/span><\/label><label id=\"forminator-field-checkbox-14-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-14-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verlamming\"><input type=\"checkbox\" name=\"checkbox-14[]\" value=\"Verlamming\" id=\"forminator-field-checkbox-14-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-14-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verlamming<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-15\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u aan uw huid? (benoem alles)<\/span><label id=\"forminator-field-checkbox-15-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Blaren\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"one\" id=\"forminator-field-checkbox-15-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Blaren<\/span><\/label><label id=\"forminator-field-checkbox-15-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Droge huid\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"two\" id=\"forminator-field-checkbox-15-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Droge huid<\/span><\/label><label id=\"forminator-field-checkbox-15-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Gevoelloosheid of trillingen\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Gevoelloosheid-of-trillingen\" id=\"forminator-field-checkbox-15-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Gevoelloosheid of trillingen<\/span><\/label><label id=\"forminator-field-checkbox-15-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Jeuk\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Jeuk\" id=\"forminator-field-checkbox-15-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Jeuk<\/span><\/label><label id=\"forminator-field-checkbox-15-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Koude intolerantie\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Koude-intolerantie\" id=\"forminator-field-checkbox-15-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Koude intolerantie<\/span><\/label><label id=\"forminator-field-checkbox-15-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Langzaam genezende wondjes\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Langzaam-genezende-wondjes\" id=\"forminator-field-checkbox-15-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Langzaam genezende wondjes<\/span><\/label><label id=\"forminator-field-checkbox-15-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Mee-eters\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Mee-eters\" id=\"forminator-field-checkbox-15-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Mee-eters<\/span><\/label><label id=\"forminator-field-checkbox-15-8-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-8-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Pijnlijke huid\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Pijnlijke-huid\" id=\"forminator-field-checkbox-15-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-8-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Pijnlijke huid<\/span><\/label><label id=\"forminator-field-checkbox-15-9-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-9-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Puistjes\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Puistjes\" id=\"forminator-field-checkbox-15-9-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-9-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Puistjes<\/span><\/label><label id=\"forminator-field-checkbox-15-10-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-10-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Roodheid\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Roodheid\" id=\"forminator-field-checkbox-15-10-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-10-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Roodheid<\/span><\/label><label id=\"forminator-field-checkbox-15-11-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-11-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Schilferige huid\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Schilferige-huid\" id=\"forminator-field-checkbox-15-11-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-11-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Schilferige huid<\/span><\/label><label id=\"forminator-field-checkbox-15-12-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-12-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Verlamming\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Verlamming\" id=\"forminator-field-checkbox-15-12-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-12-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Verlamming<\/span><\/label><label id=\"forminator-field-checkbox-15-13-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-13-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Warmte\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Warmte\" id=\"forminator-field-checkbox-15-13-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-13-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Warmte<\/span><\/label><label id=\"forminator-field-checkbox-15-14-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-14-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Warmte-intolerantie\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Warmte-intolerantie\" id=\"forminator-field-checkbox-15-14-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-14-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Warmte-intolerantie<\/span><\/label><label id=\"forminator-field-checkbox-15-15-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-15-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Zwelling\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Zwelling\" id=\"forminator-field-checkbox-15-15-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-15-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Zwelling<\/span><\/label><label id=\"forminator-field-checkbox-15-16-6a28b99e7b470-label\" for=\"forminator-field-checkbox-15-16-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Zweten\"><input type=\"checkbox\" name=\"checkbox-15[]\" value=\"Zweten\" id=\"forminator-field-checkbox-15-16-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-15-16-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Zweten<\/span><\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"checkbox-6\" class=\"forminator-field-checkbox forminator-col forminator-col-12 \"><div role=\"group\" class=\"forminator-field\" aria-labelledby=\"forminator-checkbox-group-6a28b99e7b470-label\"><span id=\"forminator-checkbox-group-6a28b99e7b470-label\" class=\"forminator-label\">Welke klachten ervaart u met uw ontlasting? (benoem alles)<\/span><label id=\"forminator-field-checkbox-6-1-6a28b99e7b470-label\" for=\"forminator-field-checkbox-6-1-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Branderig gevoel bij plassen\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"one\" id=\"forminator-field-checkbox-6-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-6-1-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Branderig gevoel bij plassen<\/span><\/label><label id=\"forminator-field-checkbox-6-2-6a28b99e7b470-label\" for=\"forminator-field-checkbox-6-2-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Constipatie\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"two\" id=\"forminator-field-checkbox-6-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-6-2-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Constipatie<\/span><\/label><label id=\"forminator-field-checkbox-6-3-6a28b99e7b470-label\" for=\"forminator-field-checkbox-6-3-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Diarree\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Diarree\" id=\"forminator-field-checkbox-6-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-6-3-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Diarree<\/span><\/label><label id=\"forminator-field-checkbox-6-4-6a28b99e7b470-label\" for=\"forminator-field-checkbox-6-4-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Obstipatie\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Obstipatie\" id=\"forminator-field-checkbox-6-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-6-4-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Obstipatie<\/span><\/label><label id=\"forminator-field-checkbox-6-5-6a28b99e7b470-label\" for=\"forminator-field-checkbox-6-5-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Donkere of zwarte ontlasting\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Donkere-of-zwarte-ontlasting\" id=\"forminator-field-checkbox-6-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-6-5-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Donkere of zwarte ontlasting<\/span><\/label><label id=\"forminator-field-checkbox-6-6-6a28b99e7b470-label\" for=\"forminator-field-checkbox-6-6-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Jeuk\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Veel-plassen\" id=\"forminator-field-checkbox-6-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-6-6-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Jeuk<\/span><\/label><label id=\"forminator-field-checkbox-6-7-6a28b99e7b470-label\" for=\"forminator-field-checkbox-6-7-6a28b99e7b470\" class=\"forminator-checkbox\" title=\"Veel plassen\"><input type=\"checkbox\" name=\"checkbox-6[]\" value=\"Verlamming\" id=\"forminator-field-checkbox-6-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-checkbox-6-7-6a28b99e7b470-label\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-checkbox-box\" aria-hidden=\"true\"><\/span><span class=\"forminator-checkbox-label\">Veel plassen<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-420--page-3\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-420--page-3-label\" aria-hidden=\"true\" data-step=\"3\" data-label=\"Pagina  3\" data-name=\"page-break-4\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"radio-2\" class=\"forminator-field-radio forminator-col forminator-col-12 \"><div role=\"radiogroup\" class=\"forminator-field\" aria-labelledby=\"forminator-radiogroup-6a28b99e7b470-label\"><span id=\"forminator-radiogroup-6a28b99e7b470-label\" class=\"forminator-label\">Hoe lang ervaart u al klachten?<\/span><label id=\"forminator-field-radio-2-label-1\" for=\"forminator-field-radio-2-1-6a28b99e7b470\" class=\"forminator-radio\" title=\"Enkele uren\"><input type=\"radio\" name=\"radio-2\" value=\"one\" id=\"forminator-field-radio-2-1-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-2-label-1\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Enkele uren<\/span><\/label><label id=\"forminator-field-radio-2-label-2\" for=\"forminator-field-radio-2-2-6a28b99e7b470\" class=\"forminator-radio\" title=\"Enkele dagen\"><input type=\"radio\" name=\"radio-2\" value=\"two\" id=\"forminator-field-radio-2-2-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-2-label-2\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Enkele dagen<\/span><\/label><label id=\"forminator-field-radio-2-label-3\" for=\"forminator-field-radio-2-3-6a28b99e7b470\" class=\"forminator-radio\" title=\"Een week\"><input type=\"radio\" name=\"radio-2\" value=\"Een-week\" id=\"forminator-field-radio-2-3-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-2-label-3\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Een week<\/span><\/label><label id=\"forminator-field-radio-2-label-4\" for=\"forminator-field-radio-2-4-6a28b99e7b470\" class=\"forminator-radio\" title=\"Enkele weken\"><input type=\"radio\" name=\"radio-2\" value=\"Enkele-weken\" id=\"forminator-field-radio-2-4-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-2-label-4\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Enkele weken<\/span><\/label><label id=\"forminator-field-radio-2-label-5\" for=\"forminator-field-radio-2-5-6a28b99e7b470\" class=\"forminator-radio\" title=\"Een maand\"><input type=\"radio\" name=\"radio-2\" value=\"Een-maand\" id=\"forminator-field-radio-2-5-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-2-label-5\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Een maand<\/span><\/label><label id=\"forminator-field-radio-2-label-6\" for=\"forminator-field-radio-2-6-6a28b99e7b470\" class=\"forminator-radio\" title=\"Enkele maanden\"><input type=\"radio\" name=\"radio-2\" value=\"Enkele-maanden\" id=\"forminator-field-radio-2-6-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-2-label-6\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Enkele maanden<\/span><\/label><label id=\"forminator-field-radio-2-label-7\" for=\"forminator-field-radio-2-7-6a28b99e7b470\" class=\"forminator-radio\" title=\"Een half jaar\"><input type=\"radio\" name=\"radio-2\" value=\"Een-half-jaar\" id=\"forminator-field-radio-2-7-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-2-label-7\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Een half jaar<\/span><\/label><label id=\"forminator-field-radio-2-label-8\" for=\"forminator-field-radio-2-8-6a28b99e7b470\" class=\"forminator-radio\" title=\"Meer dan een half jaar\"><input type=\"radio\" name=\"radio-2\" value=\"Meer-dan-een-half-jaar\" id=\"forminator-field-radio-2-8-6a28b99e7b470\" aria-labelledby=\"forminator-field-radio-2-label-8\" data-calculation=\"0\"   data-hidden-behavior=\"zero\"\/><span class=\"forminator-radio-bullet\" aria-hidden=\"true\"><\/span><span class=\"forminator-radio-label\">Meer dan een half jaar<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div tabindex=\"0\" role=\"tabpanel\" id=\"forminator-custom-form-420--page-4\" class=\"forminator-pagination\" aria-labelledby=\"forminator-custom-form-420--page-4-label\" aria-hidden=\"true\" data-step=\"4\" data-label=\"Pagina  4\" data-name=\"\" hidden><div class=\"forminator-pagination--content\"><div class=\"forminator-row\"><div id=\"html-1\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-1\"><label class=\"forminator-label\">Geen resultaten<\/label><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-2\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-2\"><label class=\"forminator-label\">Resultaat<\/label><p>Op basis van uw antwoorden lijkt het erop dat uw klachten kunnen passen bij:<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-3\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-3\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=319\">Acne<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-4\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-4\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=351\">ADHD<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-5\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-5\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=341\">Astma<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-6\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-6\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=365\">Staar<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-7\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-7\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=349\">Angststoornissen<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-8\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-8\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=339\">Beroerte<\/a><\/p>\n<p>Bij beroerte, bel onmiddellijk <strong>112<\/strong>!<\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-9\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-9\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=343\">COPD<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-10\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-10\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=361\">COVID-19<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-11\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-11\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=347\">Depressie<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-12\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-12\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=309\">Diabetes type 1<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-13\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-13\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=311\">Diabetes type 2<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-14\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-14\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=369\">Droge ogen syndroom<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-15\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-15\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=315\">Eczeem<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-16\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-16\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=294\">Epilepsie<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-17\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-17\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=355\">Fibromyalgie<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-18\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-18\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=367\">Glaucoom<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-19\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-19\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=359\">Griep<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-20\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-20\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=337\">Hartritmestoornissen<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-22\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-22\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=363\">Hersenvliesontsteking<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-23\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-23\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=335\">Hoge bloeddruk (Hypertensie)<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-24\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-24\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=357\">Jicht<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-25\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-25\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=345\">Longontsteking<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-26\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-26\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=300\">Maagzweer<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-27\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-27\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=280\">Migraine<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-28\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-28\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=296\">Parkinson<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-29\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-29\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=317\">Psoriasis<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-30\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-30\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=307\">Refluxziekte (GERD)<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-31\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-31\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=353\">Reuma<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-32\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-32\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=313\">Schildklierproblemen<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-33\" class=\"forminator-field-html forminator-col forminator-col-12 \"><div class=\"forminator-field forminator-merge-tags\" data-field=\"html-33\"><p><a href=\"https:\/\/justine.informatica.gsf.nl\/?p=298\">Spanningshoofdpijn<\/a><\/p><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"html-34\" class=\"forminator-field-html forminator-col 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