{"id":18217,"date":"2025-07-21T08:20:38","date_gmt":"2025-07-21T08:20:38","guid":{"rendered":"https:\/\/www.huisartsenpraktijkdevecht.nl\/?page_id=18217"},"modified":"2026-04-24T12:35:15","modified_gmt":"2026-04-24T12:35:15","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/www.huisartsenpraktijkdevecht.nl\/en\/other-healthcare-offer\/sti-consultation\/questionnaire\/","title":{"rendered":"Questionnaire"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.27.6&#8243; _module_preset=&#8221;default&#8221; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_stops=&#8221;rgba(0,0,0,0.4) 0%|rgba(0,0,0,0.4) 100%&#8221; background_color_gradient_overlays_image=&#8221;on&#8221; background_image=&#8221;https:\/\/www.huisartsenpraktijkdevecht.nl\/wp-content\/uploads\/2026\/02\/DeVecht-15_webp.webp&#8221; background_position=&#8221;top_center&#8221; background_vertical_offset=&#8221;37%&#8221; custom_margin=&#8221;||-1px||false|false&#8221; custom_padding=&#8221;8vw||8vw||true|false&#8221; custom_padding_tablet=&#8221;6vw||6vw||true|false&#8221; custom_padding_phone=&#8221;4vw||4vw||true|false&#8221; bottom_divider_style=&#8221;wave&#8221; bottom_divider_color=&#8221;#F4EDE4&#8243; bottom_divider_height=&#8221;4vw&#8221; bottom_divider_repeat=&#8221;2x&#8221; bottom_divider_height_tablet=&#8221;4vw&#8221; bottom_divider_height_phone=&#8221;4vw&#8221; bottom_divider_height_last_edited=&#8221;on|phone&#8221; bottom_divider_repeat_tablet=&#8221;2x&#8221; bottom_divider_repeat_phone=&#8221;2x&#8221; bottom_divider_repeat_last_edited=&#8221;on|tablet&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; title_text=&#8221;DeVecht-15_webp&#8221; sticky_enabled=&#8221;0&#8243;][et_pb_row _builder_version=&#8221;4.27.4&#8243; custom_margin=&#8221;0px||0px||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#F9F7F4&#8243; header_text_color=&#8221;#F9F7F4&#8243; header_font_size=&#8221;60px&#8221; header_4_font=&#8221;|300|||||||&#8221; header_4_text_color=&#8221;#F9F7F4&#8243; header_4_font_size=&#8221;35px&#8221; custom_margin=&#8221;||||false|false&#8221; header_font_size_tablet=&#8221;45px&#8221; header_font_size_phone=&#8221;32px&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; header_4_font_size_tablet=&#8221;30px&#8221; header_4_font_size_phone=&#8221;24px&#8221; header_4_font_size_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h1>Vragenlijst<\/h1>\n<p>Zou je onderstaande vragen zo goed mogelijk willen beantwoorden? De ingevulde vragenlijst wordt tijdens het spreekuur met jou besproken. Er wordt vertrouwelijk met de ingevulde vragenlijst omgegaan.<\/p>\n<p>[\/et_pb_text][et_pb_button button_url=&#8221;\/afspraak-maken\/&#8221; button_text=&#8221;Maak een afspraak&#8221; disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; button_text_color=&#8221;#F9F7F4&#8243; button_bg_color=&#8221;#6D8CA5&#8243; button_border_radius=&#8221;90px&#8221; button_use_icon=&#8221;off&#8221; custom_css_main_element=&#8221;float:left;||margin-right: 20px!important;&#8221; disabled=&#8221;on&#8221; global_module=&#8221;17687&#8243; saved_tabs=&#8221;all&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; button_border_width__hover=&#8221;0px&#8221; button_bg_color__hover=&#8221;#9BB6C9&#8243; custom_css_main_element_last_edited=&#8221;on|phone&#8221; custom_css_main_element_phone=&#8221;float:left;||margin-bottom: 20px!important;&#8221; custom_css_main_element_tablet=&#8221;float:left;||margin-right: 20px!important;&#8221;][\/et_pb_button][et_pb_button button_url=&#8221;tel:0505262600&#8243; button_text=&#8221;Voor spoed bel: 050-526 26 00&#8243; disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; button_text_color=&#8221;#F9F7F4&#8243; button_bg_color=&#8221;#7CA098&#8243; button_border_radius=&#8221;90px&#8221; button_use_icon=&#8221;off&#8221; custom_css_main_element=&#8221;float:left;||margin-right: 20px!important;&#8221; disabled=&#8221;on&#8221; global_module=&#8221;17783&#8243; saved_tabs=&#8221;all&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; button_border_width__hover=&#8221;0px&#8221; button_bg_color__hover=&#8221;#B6C5B2&#8243; custom_css_main_element_last_edited=&#8221;on|phone&#8221; custom_css_main_element_phone=&#8221;float:left;||margin-bottom: 20px!important;&#8221; custom_css_main_element_tablet=&#8221;float:left;||margin-right: 20px!important;&#8221; button_border_radius__hover=&#8221;90px&#8221;][\/et_pb_button][et_pb_blurb title=&#8221;Nieuwe patient?&#8221; url=&#8221;\/inschrijven\/&#8221; image=&#8221;https:\/\/www.huisartsenpraktijkdevecht.nl\/wp-content\/uploads\/2025\/06\/Schrijf-je-in.svg&#8221; image_icon_width=&#8221;50px&#8221; disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; header_text_color=&#8221;#F9F7F4&#8243; body_text_color=&#8221;#F9F7F4&#8243; body_link_font=&#8221;||||on|||#F9F7F4|&#8221; body_link_text_color=&#8221;#F9F7F4&#8243; link_option_url=&#8221;\/inschrijven\/&#8221; custom_css_main_element=&#8221;float: left;||margin-right: 20px!important;&#8221; custom_css_blurb_title=&#8221;margin-top:8px;||margin-bottom:-10px;&#8221; disabled=&#8221;on&#8221; global_module=&#8221;17688&#8243; saved_tabs=&#8221;all&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221; custom_css_main_element_last_edited=&#8221;on|desktop&#8221; custom_css_main_element_tablet=&#8221;float: left;&#8221; custom_css_main_element_phone=&#8221;float: left;&#8221;]<\/p>\n<p>Schrijf je in!<\/p>\n<p>[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#F4EDE4&#8243; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_repeat=&#8221;on&#8221; background_color_gradient_stops=&#8221;#f4ede4 0%|#f9f7f4 100%&#8221; background_color_gradient_overlays_image=&#8221;on&#8221; background_enable_image=&#8221;off&#8221; background_size=&#8221;initial&#8221; background_position=&#8221;top_center&#8221; background_vertical_offset=&#8221;-23%&#8221; custom_margin=&#8221;0px||0px||true|false&#8221; custom_padding=&#8221;100px||100px||true|false&#8221; custom_padding_tablet=&#8221;60px||60px||true|false&#8221; custom_padding_phone=&#8221;40px||40px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row column_structure=&#8221;3_5,2_5&#8243; use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;2&#8243; module_id=&#8221;contact&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_margin=&#8221;0px||0px||true|false&#8221; custom_padding=&#8221;0px||0px||true|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;3_5&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; link_font=&#8221;|600|||on|||#6D8CA5|&#8221; link_text_color=&#8221;#6D8CA5&#8243; header_2_font_size=&#8221;35px&#8221; header_3_font=&#8221;|700|||||||&#8221; header_3_font_size=&#8221;24px&#8221; custom_margin=&#8221;||40px||false|false&#8221; header_2_font_size_tablet=&#8221;30px&#8221; header_2_font_size_phone=&#8221;24px&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; header_3_font_size_tablet=&#8221;20px&#8221; header_3_font_size_phone=&#8221;18px&#8221; header_3_font_size_last_edited=&#8221;on|phone&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Formulier SOA<\/h2>\n<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_19' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_19'  action='\/en\/wp-json\/wp\/v2\/pages\/18217' data-formid='19' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LeqG14rAAAAAPNhgp2n3pYcC5Fz6bExBgTeCpNC' data-tabindex='0'><input id=\"input_e828e2aa5b5386a11afe61d387977d59\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_e828e2aa5b5386a11afe61d387977d59\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_19_31\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_31'>Company<\/label><div class='ginput_container'><input name='input_31' id='input_19_31' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_19_31'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_19_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Persoonsgegevens<\/h3><\/li><li id=\"field_19_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_5'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_19_5' type='text' value='' class='large'    placeholder='Voornaam Achternaam' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Geslacht<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_24'>\n\t\t\t<li class='gchoice gchoice_19_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='Man'  id='choice_19_24_0'    \/>\n\t\t\t\t<label for='choice_19_24_0' id='label_19_24_0' class='gform-field-label gform-field-label--type-inline'>Man<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='Vrouw'  id='choice_19_24_1'    \/>\n\t\t\t\t<label for='choice_19_24_1' id='label_19_24_1' class='gform-field-label gform-field-label--type-inline'>Vrouw<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_21\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_21'>Geboortedatum<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_21' id='input_19_21' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_21_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_19_21_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_21' class='gform_hidden' value='https:\/\/www.huisartsenpraktijkdevecht.nl\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_19_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_3'>Telefoonnummer<\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_19_3' type='tel' value='' class='large'  placeholder='(+31) 6 123 456 78'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_30\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_30'>E-mailadres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_30' id='input_19_30' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_19_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_12'>Nationaliteit<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_19_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_13'>Geboorteland<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_19_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_14\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Vragenlijst<\/h3><\/li><li id=\"field_19_6\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_6'>Wat is de reden dat u voor een soa-test komt?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_6' id='input_19_6' class='textarea small'    placeholder='Voor overige vragen kun je dit veld invullen.'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Heeft u eerder een soa gehad?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_10'>\n\t\t\t<li class='gchoice gchoice_19_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='Ja'  id='choice_19_10_0'    \/>\n\t\t\t\t<label for='choice_19_10_0' id='label_19_10_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='Nee'  id='choice_19_10_1'    \/>\n\t\t\t\t<label for='choice_19_10_1' id='label_19_10_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Heeft uw sekspartner ooit een soa gehad?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_17'>\n\t\t\t<li class='gchoice gchoice_19_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='Ja'  id='choice_19_17_0'    \/>\n\t\t\t\t<label for='choice_19_17_0' id='label_19_17_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='Nee'  id='choice_19_17_1'    \/>\n\t\t\t\t<label for='choice_19_17_1' id='label_19_17_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_17_2'>\n\t\t\t\t<input name='input_17' type='radio' value='Onbekend'  id='choice_19_17_2'    \/>\n\t\t\t\t<label for='choice_19_17_2' id='label_19_17_2' class='gform-field-label gform-field-label--type-inline'>Onbekend<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_18\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_18'>Heeft u in het afgelopen halfjaar onveilig seksueel contact gehad?<\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_19_18' class='large gfield_select'     aria-invalid=\"false\" ><option value='Nee' >Nee<\/option><option value='Ja, seks zonder condoom' >Ja, seks zonder condoom<\/option><option value='Ja, condoom afgescheurd \/ afgegleden' >Ja, condoom afgescheurd \/ afgegleden<\/option><\/select><\/div><\/li><li id=\"field_19_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_19'>Heeft uw sekspartner(s) in het afgelopen halfjaar onveilig seksueel contact gehad?<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_19_19' class='large gfield_select'     aria-invalid=\"false\" ><option value='Nee' >Nee<\/option><option value='Ja, seks zonder condoom' >Ja, seks zonder condoom<\/option><option value='Ja, condoom afgescheurd \/ afgegleden' >Ja, condoom afgescheurd \/ afgegleden<\/option><option value='Onbekend' >Onbekend<\/option><\/select><\/div><\/li><li id=\"field_19_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_23'>Op welke manier had u (onveilig) seksueel contact?<\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_19_23' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oraal contact (= mond - penis\/vagina\/anus)' >Oraal contact (= mond - penis\/vagina\/anus)<\/option><option value='Genitaal contact (= penis - vagina)' >Genitaal contact (= penis - vagina)<\/option><option value='Anaal contact (= penis - anus)' >Anaal contact (= penis - anus)<\/option><option value='Combinatie van bovengenoemde' >Combinatie van bovengenoemde<\/option><\/select><\/div><\/li><li id=\"field_19_11\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_11'>Wat is de datum van het laatste onveilige seksuele contact?<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_11' id='input_19_11' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_11_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_19_11_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_11' class='gform_hidden' value='https:\/\/www.huisartsenpraktijkdevecht.nl\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_19_22\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_22'>Hoeveel sekspartners heeft u in het afgelopen halfjaar gehad?<\/label><div class='ginput_container ginput_container_number'><input name='input_22' id='input_19_22' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_19_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_20'>Heeft u in het afgelopen halfjaar seksueel contact gehad met:<\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_19_20' class='large gfield_select'     aria-invalid=\"false\" ><option value='Mannen' >Mannen<\/option><option value='Vrouwen' >Vrouwen<\/option><option value='Zowel mannen als vrouwen' >Zowel mannen als vrouwen<\/option><\/select><\/div><\/li><li id=\"field_19_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Kan er sprake zijn van een zwangerschap (alleen voor vrouwen)?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_16'>\n\t\t\t<li class='gchoice gchoice_19_16_0'>\n\t\t\t\t<input name='input_16' type='radio' value='Ja'  id='choice_19_16_0'    \/>\n\t\t\t\t<label for='choice_19_16_0' id='label_19_16_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_16_1'>\n\t\t\t\t<input name='input_16' type='radio' value='Nee'  id='choice_19_16_1'    \/>\n\t\t\t\t<label for='choice_19_16_1' id='label_19_16_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_16_2'>\n\t\t\t\t<input name='input_16' type='radio' value='Onbekend'  id='choice_19_16_2'    \/>\n\t\t\t\t<label for='choice_19_16_2' id='label_19_16_2' class='gform-field-label gform-field-label--type-inline'>Onbekend<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_25\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Heeft u seksueel contact gehad tegen betaling?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_25'>\n\t\t\t<li class='gchoice gchoice_19_25_0'>\n\t\t\t\t<input name='input_25' type='radio' value='Ja'  id='choice_19_25_0'    \/>\n\t\t\t\t<label for='choice_19_25_0' id='label_19_25_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_25_1'>\n\t\t\t\t<input name='input_25' type='radio' value='Nee'  id='choice_19_25_1'    \/>\n\t\t\t\t<label for='choice_19_25_1' id='label_19_25_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_26\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Heeft u drugs per injectie gebruikt?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_26'>\n\t\t\t<li class='gchoice gchoice_19_26_0'>\n\t\t\t\t<input name='input_26' type='radio' value='Ja'  id='choice_19_26_0'    \/>\n\t\t\t\t<label for='choice_19_26_0' id='label_19_26_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_26_1'>\n\t\t\t\t<input name='input_26' type='radio' value='Nee'  id='choice_19_26_1'    \/>\n\t\t\t\t<label for='choice_19_26_1' id='label_19_26_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Bent u inge\u00ebnt tegen hepatitis B?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_27'>\n\t\t\t<li class='gchoice gchoice_19_27_0'>\n\t\t\t\t<input name='input_27' type='radio' value='Ja'  id='choice_19_27_0'    \/>\n\t\t\t\t<label for='choice_19_27_0' id='label_19_27_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_27_1'>\n\t\t\t\t<input name='input_27' type='radio' value='Nee'  id='choice_19_27_1'    \/>\n\t\t\t\t<label for='choice_19_27_1' id='label_19_27_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Heeft u behoefte aan informatie over veilig vrijen?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_28'>\n\t\t\t<li class='gchoice gchoice_19_28_0'>\n\t\t\t\t<input name='input_28' type='radio' value='Ja'  id='choice_19_28_0'    \/>\n\t\t\t\t<label for='choice_19_28_0' id='label_19_28_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_28_1'>\n\t\t\t\t<input name='input_28' type='radio' value='Nee'  id='choice_19_28_1'    \/>\n\t\t\t\t<label for='choice_19_28_1' id='label_19_28_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_29\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_29'>Zijn er nog andere zaken die wij moeten 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url_new_window=&#8221;on&#8221;]facebook[\/et_pb_social_media_follow_network][et_pb_social_media_follow_network social_network=&#8221;instagram&#8221; url=&#8221;https:\/\/www.instagram.com\/huisartsenpraktijkdevecht\/&#8221; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#9BB6C9&#8243; background_enable_color=&#8221;on&#8221; border_radii=&#8221;on|923px|923px|923px|923px&#8221; border_color_all=&#8221;#F9F7F4&#8243; global_colors_info=&#8221;{}&#8221; follow_button=&#8221;off&#8221; url_new_window=&#8221;on&#8221;]instagram[\/et_pb_social_media_follow_network][\/et_pb_social_media_follow][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#F9F7F4&#8243; link_text_color=&#8221;#F9F7F4&#8243; header_2_text_color=&#8221;#F9F7F4&#8243; header_3_text_color=&#8221;#F9F7F4&#8243; header_3_font_size=&#8221;18px&#8221; header_4_text_color=&#8221;#F9F7F4&#8243; header_4_font_size=&#8221;22px&#8221; background_color=&#8221;#7CA098&#8243; background_image=&#8221;https:\/\/www.huisartsenpraktijkdevecht.nl\/wp-content\/uploads\/2025\/06\/wave-groen.svg&#8221; background_size=&#8221;contain&#8221; custom_padding=&#8221;30px|30px|30px|30px|true|true&#8221; custom_padding_tablet=&#8221;30px|30px|30px|30px|true|true&#8221; custom_padding_phone=&#8221;20px|20px|20px|20px|true|true&#8221; custom_padding_last_edited=&#8221;on|phone&#8221; header_2_font_size_tablet=&#8221;22px&#8221; header_2_font_size_phone=&#8221;20px&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; header_4_font_size_tablet=&#8221;22px&#8221; header_4_font_size_phone=&#8221;20px&#8221; header_4_font_size_last_edited=&#8221;on|phone&#8221; custom_css_free_form=&#8221;.entry-content tr td {||    border-top: 0px solid #eee;||    padding: 0px;||}||.entry-content table:not(.variations) {||  border: 0px;||margin: 0px;||}&#8221; border_radii=&#8221;off|70px|10px|10px|10px&#8221; global_module=&#8221;17696&#8243; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Adres<\/h2>\n<p>Vechtstraat 80<br \/>9725CW Groningen<\/p>\n<h2>Telefoonnummers<\/h2>\n<table border=\"0\" style=\"border-collapse: collapse; width: 100%;\">\n<tbody>\n<tr>\n<td style=\"width: 50%;\">Telefoon:<br \/>Spoedlijn:<br \/>Receptenlijn:<\/td>\n<td style=\"width: 50%;\"><a href=\"tel:0505259499\">050-525 94 99<\/a><br \/><a href=\"tel:0505262600\">050-526 26 00<\/a><br \/><a href=\"tel:0505279717\">050-527 97 17<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><\/h2>\n<h2>E-mailadres<\/h2>\n<p><a href=\"mailto:info@huisartsenpraktijkdevecht.nl\">info@huisartsenpraktijkdevecht.nl<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Vragenlijst Zou je onderstaande vragen zo goed mogelijk willen beantwoorden? De ingevulde vragenlijst wordt tijdens het spreekuur met jou besproken. Er wordt vertrouwelijk met de ingevulde vragenlijst omgegaan.Schrijf je in! Formulier SOA \n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_19' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_19'  action='\/en\/wp-json\/wp\/v2\/pages\/18217' data-formid='19' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6LeqG14rAAAAAPNhgp2n3pYcC5Fz6bExBgTeCpNC' data-tabindex='0'><input id=\"input_e828e2aa5b5386a11afe61d387977d59\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_e828e2aa5b5386a11afe61d387977d59\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_19' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_19_31\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_31'>URL<\/label><div class='ginput_container'><input name='input_31' id='input_19_31' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_19_31'>This field is for validation purposes and should be left unchanged.<\/div><\/li><li id=\"field_19_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Persoonsgegevens<\/h3><\/li><li id=\"field_19_5\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_5'>Naam<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_19_5' type='text' value='' class='large'    placeholder='Voornaam Achternaam' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_24\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Geslacht<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_24'>\n\t\t\t<li class='gchoice gchoice_19_24_0'>\n\t\t\t\t<input name='input_24' type='radio' value='Man'  id='choice_19_24_0'    \/>\n\t\t\t\t<label for='choice_19_24_0' id='label_19_24_0' class='gform-field-label gform-field-label--type-inline'>Man<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_24_1'>\n\t\t\t\t<input name='input_24' type='radio' value='Vrouw'  id='choice_19_24_1'    \/>\n\t\t\t\t<label for='choice_19_24_1' id='label_19_24_1' class='gform-field-label gform-field-label--type-inline'>Vrouw<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_21\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_21'>Geboortedatum<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_21' id='input_19_21' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_21_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_19_21_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_21' class='gform_hidden' value='https:\/\/www.huisartsenpraktijkdevecht.nl\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_19_3\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_3'>Telefoonnummer<\/label><div class='ginput_container ginput_container_phone'><input name='input_3' id='input_19_3' type='tel' value='' class='large'  placeholder='(+31) 6 123 456 78'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_30\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_30'>E-mailadres<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_30' id='input_19_30' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_19_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_12'>Nationaliteit<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_19_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_13'>Geboorteland<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_19_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_19_14\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Vragenlijst<\/h3><\/li><li id=\"field_19_6\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_6'>Wat is de reden dat u voor een soa-test komt?<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_6' id='input_19_6' class='textarea small'    placeholder='Voor overige vragen kun je dit veld invullen.'  aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_19_10\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Heeft u eerder een soa gehad?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_10'>\n\t\t\t<li class='gchoice gchoice_19_10_0'>\n\t\t\t\t<input name='input_10' type='radio' value='Ja'  id='choice_19_10_0'    \/>\n\t\t\t\t<label for='choice_19_10_0' id='label_19_10_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_10_1'>\n\t\t\t\t<input name='input_10' type='radio' value='Nee'  id='choice_19_10_1'    \/>\n\t\t\t\t<label for='choice_19_10_1' id='label_19_10_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Heeft uw sekspartner ooit een soa gehad?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_19_17'>\n\t\t\t<li class='gchoice gchoice_19_17_0'>\n\t\t\t\t<input name='input_17' type='radio' value='Ja'  id='choice_19_17_0'    \/>\n\t\t\t\t<label for='choice_19_17_0' id='label_19_17_0' class='gform-field-label gform-field-label--type-inline'>Ja<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_17_1'>\n\t\t\t\t<input name='input_17' type='radio' value='Nee'  id='choice_19_17_1'    \/>\n\t\t\t\t<label for='choice_19_17_1' id='label_19_17_1' class='gform-field-label gform-field-label--type-inline'>Nee<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_19_17_2'>\n\t\t\t\t<input name='input_17' type='radio' value='Onbekend'  id='choice_19_17_2'    \/>\n\t\t\t\t<label for='choice_19_17_2' id='label_19_17_2' class='gform-field-label gform-field-label--type-inline'>Onbekend<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_19_18\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_18'>Heeft u in het afgelopen halfjaar onveilig seksueel contact gehad?<\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_19_18' class='large gfield_select'     aria-invalid=\"false\" ><option value='Nee' >Nee<\/option><option value='Ja, seks zonder condoom' >Ja, seks zonder condoom<\/option><option value='Ja, condoom afgescheurd \/ afgegleden' >Ja, condoom afgescheurd \/ afgegleden<\/option><\/select><\/div><\/li><li id=\"field_19_19\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_19'>Heeft uw sekspartner(s) in het afgelopen halfjaar onveilig seksueel contact gehad?<\/label><div class='ginput_container ginput_container_select'><select name='input_19' id='input_19_19' class='large gfield_select'     aria-invalid=\"false\" ><option value='Nee' >Nee<\/option><option value='Ja, seks zonder condoom' >Ja, seks zonder condoom<\/option><option value='Ja, condoom afgescheurd \/ afgegleden' >Ja, condoom afgescheurd \/ afgegleden<\/option><option value='Onbekend' >Onbekend<\/option><\/select><\/div><\/li><li id=\"field_19_23\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_23'>Op welke manier had u (onveilig) seksueel contact?<\/label><div class='ginput_container ginput_container_select'><select name='input_23' id='input_19_23' class='large gfield_select'     aria-invalid=\"false\" ><option value='Oraal contact (= mond - penis\/vagina\/anus)' >Oraal contact (= mond - penis\/vagina\/anus)<\/option><option value='Genitaal contact (= penis - vagina)' >Genitaal contact (= penis - vagina)<\/option><option value='Anaal contact (= penis - anus)' >Anaal contact (= penis - anus)<\/option><option value='Combinatie van bovengenoemde' >Combinatie van bovengenoemde<\/option><\/select><\/div><\/li><li id=\"field_19_11\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_11'>Wat is de datum van het laatste onveilige seksuele contact?<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_11' id='input_19_11' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/yyyy' aria-describedby=\"input_19_11_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_19_11_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_19_11' class='gform_hidden' value='https:\/\/www.huisartsenpraktijkdevecht.nl\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_19_22\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_22'>Hoeveel sekspartners heeft u in het afgelopen halfjaar gehad?<\/label><div class='ginput_container ginput_container_number'><input name='input_22' id='input_19_22' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_19_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_19_20'>Heeft u in het afgelopen halfjaar seksueel contact gehad met:<\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_19_20' class='large gfield_select'     aria-invalid=\"false\" ><option value='Mannen' >Mannen<\/option><option value='Vrouwen' >Vrouwen<\/option><option value='Zowel mannen als vrouwen' >Zowel mannen als vrouwen<\/option><\/select><\/div><\/li><li id=\"field_19_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' >Kan 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Adres Vechtstraat 809725CW Groningen Telefoonnummers [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":18214,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-18217","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.8 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Vragenlijst - Huisartsenpraktijk de Vecht<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.huisartsenpraktijkdevecht.nl\/en\/other-healthcare-offer\/sti-consultation\/questionnaire\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Vragenlijst - Huisartsenpraktijk de Vecht\" \/>\n<meta property=\"og:description\" content=\"Vragenlijst Zou je onderstaande vragen zo goed mogelijk willen beantwoorden? 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