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{"id":79,"date":"2019-01-24T15:09:55","date_gmt":"2019-01-24T15:09:55","guid":{"rendered":"http:\/\/exhoso.de\/?page_id=79"},"modified":"2019-02-21T21:43:09","modified_gmt":"2019-02-21T21:43:09","slug":"fragebogen-zur-bedarfsanalyse-seniorenbetreuung","status":"publish","type":"page","link":"https:\/\/exhoso.de\/fragebogen-zur-bedarfsanalyse-seniorenbetreuung\/","title":{"rendered":"Fragebogen zur Bedarfsanalyse \u2013 Seniorenbetreuung"},"content":{"rendered":"<section class=\"wpb-content-wrapper\"><p>[vc_row][vc_column width=&#8221;1\/6&#8243;][\/vc_column][vc_column width=&#8221;2\/3&#8243;]<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f80-o1\" lang=\"hu-HU\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><\/div>\n<form action=\"\/wp-json\/wp\/v2\/pages\/79#wpcf7-f80-o1\" method=\"post\" class=\"wpcf7-form\" novalidate=\"novalidate\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"80\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.1.1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"hu_HU\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f80-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"g-recaptcha-response\" value=\"\" \/>\n<\/div>\n<div class=\"col-md-12 col-lg-12 col-xs-12\">\n<div class=\"row\">\n<div class=\"col-md-12 col-lg-12 col-xs-12\">\n<h3>Pers\u00f6nliche Angaben - Kontaktperson<\/h3>\n<\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-6 col-lg-6 col-xs-12 simacimke\">\n\t\t\t<label>Vorname*:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-03\"><input type=\"text\" name=\"text-03\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"col-md-6 col-lg-6 col-xs-12 simacimke\">\n\t\t\t<label>Nachname*:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-04\"><input type=\"text\" name=\"text-04\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-6 col-lg-6 col-xs-12 simacimke\">\n\t\t\t<label>PLZ:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-06\"><input type=\"text\" name=\"text-06\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"col-md-6 col-lg-6 col-xs-12 simacimke\">\n\t\t\t<label>Ort:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-07\"><input type=\"text\" name=\"text-07\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-4 col-lg-4 col-xs-12 simacimke\">\n\t\t\t<label>Email*:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap email-908\"><input type=\"email\" name=\"email-908\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"col-md-4 col-lg-4 col-xs-12 simacimke\">\n\t\t\t<label>Telefonnummer:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-08\"><input type=\"text\" name=\"text-08\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"col-md-4 col-lg-4 col-xs-12 simacimke\">\n\t\t\t<label>Mobilnummer:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-999\"><input type=\"text\" name=\"text-999\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-12 col-lg-12 col-xs-12\">\n<h3>Pers\u00f6nliche Angaben - zu betreuende Person<\/h3>\n<\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-6 col-lg-6 col-xs-12 simacimke\">\n\t\t\t<label>Vorname:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-003\"><input type=\"text\" name=\"text-003\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"col-md-6 col-lg-6 col-xs-12 simacimke\">\n\t\t\t<label>Nachname:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-004\"><input type=\"text\" name=\"text-004\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-4 col-lg-4 col-xs-12 simacimke\">\n\t\t\t<label>Stra\u00dfe und Hausnummer:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-005\"><input type=\"text\" name=\"text-005\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"col-md-4 col-lg-4 col-xs-12 simacimke\">\n\t\t\t<label>PLZ:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-006\"><input type=\"text\" name=\"text-006\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"col-md-4 col-lg-4 col-xs-12 simacimke\">\n\t\t\t<label>Ort:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-007\"><input type=\"text\" name=\"text-007\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-6 col-lg-6 col-xs-12 simacimke\">\n\t\t\t<label>Telefonnummer:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-008\"><input type=\"text\" name=\"text-008\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"col-md-6 col-lg-6 col-xs-12 simacimke\">\n\t\t\t<label>Geburtsjahr:<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap text-955\"><input type=\"text\" name=\"text-955\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" \/><\/span>\n\t\t<\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-12 col-lg-12 col-xs-12 egymasmellettcimke\">\n<div class=\"egybecimkekkel\"><label>Wohnfl\u00e4che:<\/label><span class=\"wpcf7-form-control-wrap radio-09\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-09\" value=\"unter 150 m^2\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">unter 150 m^2<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-09\" value=\"zwischen 150 und 300 m^2\" \/><span class=\"wpcf7-list-item-label\">zwischen 150 und 300 m^2<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-09\" value=\"\u00fcber 300 m^2\" \/><span class=\"wpcf7-list-item-label\">\u00fcber 300 m^2<\/span><\/span><\/span><\/span><\/div><\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-12 col-lg-12 col-xs-12 egymasmellettcimke\">\n<h3>Zu betreuende Person im Alltag:<\/h3>\n<div class=\"egybecimkekkel\"><span class=\"wpcf7-form-control-wrap checkbox-470\"><span class=\"wpcf7-form-control wpcf7-checkbox\"><span class=\"wpcf7-list-item first\"><input type=\"checkbox\" name=\"checkbox-470[]\" value=\"eigenst\u00e4ndig\" \/><span class=\"wpcf7-list-item-label\">eigenst\u00e4ndig<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"checkbox-470[]\" value=\"teilweise eingeschr\u00e4nkt\" \/><span class=\"wpcf7-list-item-label\">teilweise eingeschr\u00e4nkt<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"checkbox\" name=\"checkbox-470[]\" value=\"\u00fcberwiegend eingeschr\u00e4nkt\" \/><span class=\"wpcf7-list-item-label\">\u00fcberwiegend eingeschr\u00e4nkt<\/span><\/span><\/span><\/span><\/div><\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-12 col-lg-12 col-xs-12 egymasmellettcimke\">\n<h3>Erwartungen an die Hilfskraft<\/h3>\n<div class=\"egybecimkekkel\"><label>Beginn der T\u00e4tigkeit<\/label><span class=\"wpcf7-form-control-wrap radio-19\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-19\" value=\"fr\u00fchestm\u00f6glich\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">fr\u00fchestm\u00f6glich<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-19\" value=\"Wunschbeginn\" \/><span class=\"wpcf7-list-item-label\">Wunschbeginn<\/span><\/span><\/span><\/span><span class=\"wpcf7-form-control-wrap text-630\"><input type=\"text\" name=\"text-630\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" id=\"kezdesidopont\" aria-invalid=\"false\" placeholder=\"Datum eingeben\" \/><\/span><\/div>\n<div class=\"egybecimkekkel\"><label>Deutschkenntnisse<\/label><span class=\"wpcf7-form-control-wrap radio-20\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-20\" value=\"gute Kenntnisse\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">gute Kenntnisse<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"radio-20\" value=\"Grundkenntnisse\" \/><span class=\"wpcf7-list-item-label\">Grundkenntnisse<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-20\" value=\"nicht relevant\" \/><span class=\"wpcf7-list-item-label\">nicht relevant<\/span><\/span><\/span><\/span><\/div><\/div>\n<div class=\"clear clearfix\"><\/div>\n<div class=\"col-md-12 col-lg-12 col-xs-12 egymasmellettcimke egybecimkekkel\">\n\t\t\t<label>individuelle Erwartungen<\/label><br \/>\n\t\t\t<span class=\"wpcf7-form-control-wrap textarea-21\"><textarea name=\"textarea-21\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\"><\/textarea><\/span><\/p>\n<div class=\"clear clearfix\"><\/div>\n<p>\t\t\t<input type=\"submit\" value=\"Senden\" class=\"wpcf7-form-control wpcf7-submit\" id=\"formkuldes\" \/><br \/>\n<i>Nehmen Sie bitte zur Kenntnis, dass das Ziel unseres Teams die Erh\u00f6hung der Lebensqualit\u00e4t durch eine individuelle Betreuung in den eigenen vier W\u00e4nden ist. <\/i><br \/>\n<i>Bei jeglichen Fragen stehen wir Ihnen jederzeit gerne zur Verf\u00fcgung!<\/i><br \/>\n<b>Bitte beachten Sie, dass wir die genauen Bed\u00fcrfnisse und W\u00fcnsche noch einmal bei einem pers\u00f6nlichen Gespr\u00e4ch gerne aufnehmen werden.<\/b><\/p><\/div><\/div>\n<\/div>\n<div class=\"wpcf7-response-output wpcf7-display-none\"><\/div><\/form><\/div>[\/vc_column][vc_column 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