Rezepteinreichung
Du hast eine ärztliche Verordnung (Rezept) bekommen?
Dann bist du bei uns genau richtig. Egal ob gesetzlich oder privat versichert, wir kümmern uns um deine Heilmittelverordnung und sorgen dafür, dass du schnell einen passenden Termin bekommst.
Damit es für dich besonders einfach geht, kannst du dein Rezept direkt hier online einreichen. So sparen wir beide Zeit und du kannst sicher sein, dass deine Behandlung ohne lange Wartezeiten starten kann.
Trage hier die Daten vom Rezept ein
Wir melden uns bei dir.
{"url":"\/rezept-einreichen","form_action_on_submit":"display_text","form_action_on_submit_text":"Vielen Dank f\u00fcr das Einreichen des Rezeptes, wir melden uns schnellstm\u00f6glich bei dir.","form_include_text_fields_in_notification_emails":null,"rows":[{"columns":[{"columnWidth":null,"fields":[{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-2","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-2","field_type":"input_text","field_label":"Vorname*","field_placeholder":"Vorname","field_required":"1","field_label_required_error":"","field_hidden":null},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-3","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-3","field_type":"input_text","field_label":"Nachname*","field_placeholder":"Nachname","field_required":"1","field_label_required_error":"","field_hidden":null},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-4","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-4","field_type":"input_text","field_label":"Krankenkasse","field_placeholder":"Krankenkasse","field_required":null,"field_label_required_error":"","field_hidden":null},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-5","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-5","field_type":"input_text","field_label":"Heilmittel nach Ma\u00dfgabe des Katalogs","field_placeholder":"Heilmittel","field_required":null,"field_label_required_error":"","field_hidden":null},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-6","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-6","field_type":"input_text","field_label":"Erg\u00e4nzendes Heilmittel","field_placeholder":"Erg\u00e4nzendes Heilmittel","field_required":null,"field_label_required_error":"","field_hidden":null},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-7","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-7","field_type":"input_number","field_label":"Telefon*","field_placeholder":"Telefon","field_required":"1","field_label_required_error":"","field_hidden":null},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-8","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-8","field_type":"input_email","field_label":"E-Mail*","field_placeholder":"E-Mail","field_required":"1","field_label_required_error":"","field_hidden":null},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-16","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-16","field_type":"radio","field_label":"Akute Schmerzen \/ Beschwerden","field_placeholder":"","field_required":null,"field_label_required_error":"","field_hidden":null,"field_select_multiple":null,"field_label_no_option":"","options":[{"option_label":"Ja","option_value":"Ja","option_selected":false,"option_assigned_groups":null},{"option_label":"Nein","option_value":"Nein","option_selected":false,"option_assigned_groups":null}]},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-10","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-10","field_type":"checkbox","field_label":"Erreichbarkeit zur Terminfindung*","field_placeholder":"","field_required":"1","field_label_required_error":"","field_hidden":null,"field_select_multiple":null,"field_label_no_option":"","options":[{"option_label":"9-12 Uhr","option_value":"9-12 Uhr","option_selected":false,"option_assigned_groups":null},{"option_label":"12-16 Uhr","option_value":"12-16 Uhr","option_selected":false,"option_assigned_groups":null},{"option_label":"16-20 Uhr","option_value":"16-20 Uhr","option_selected":false,"option_assigned_groups":null}]},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-13","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-13","field_type":"textarea","field_label":"Deine Nachricht an uns","field_placeholder":"Nachricht","field_required":null,"field_label_required_error":"","field_hidden":null},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-15","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-15","field_type":"checkbox","field_label":"Datenschutz*","field_placeholder":"","field_required":"1","field_label_required_error":"","field_hidden":null,"field_select_multiple":null,"field_label_no_option":"","options":[{"option_label":"Ich bin einverstanden","option_value":"einverstanden","option_selected":false,"option_assigned_groups":null}]},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-17","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-17","field_type":"text","text":"<p class=\"p-small\">Mit dem Absenden erkl\u00e4rst du dich damit einverstanden, dass wir die von dir angegebenen Daten ausschlie\u00dflich zur Bearbeitung deiner Rezeptanfrage und zur Terminvereinbarung nutzen. Eine Weitergabe an Dritte erfolgt nicht. Weitere Informationen findest du in unserer <a href=\"\/datenschutz\" target=\"_self\">Datenschutzerkl\u00e4rung<\/a><\/p>"},{"field_id":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-1","field_name":"d5876ee9-c6be-42ea-b22c-fbc6da3e3e79-field-1","field_type":"button","field_label":"Absenden","buttonClasses":"wsw-block-button-default wsw-button-solid wsw-button-pill wsw-button-meduim"}]}]}]}
{"no_option":"Keine Option","subscribe_to_newsletter":"Newsletter abonnieren","subscribe_to_newsletter_yes":"Ja","subscribe_to_newsletter_no":"Nein","send_form_to_me_label":"Kopie an mich senden","choose_file":"Datei ausw\u00e4hlen","invalid_email":"E-Mail ist nicht korrekt","email_does_not_match":"E-Mail stimmt nicht \u00fcberein","password_does_not_match":"Passwort stimmt nicht \u00fcberein","captcha_failed":"Captcha-Verifikation fehlgeschlagen. Bitte versuchen Sie es erneut.","field_required":"Dieses Feld ist notwendig","unknown_error":"Unbekannter Error. Bitte neu laden","on_submit_text":"Vielen Dank f\u00fcr das Einreichen des Formulars."}