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https://e.dokteronline.com/16/1625/16/ba242d2408d9627bc947bd4773de5972c9fed301/b2sd4kSwRTFYXAp8OXE_mQlYMkPYScMPHBV2NAyBz9bQ...
Submission: On February 02 via api from BE — Scanned from DE
Submission: On February 02 via api from BE — Scanned from DE
Form analysis 1 forms found in the DOM
Name: preference_form — POST https://e.dokteronline.com/3/4/1625/16/Sa8RT5Br-4Y1dD57CSqklA4X15W1cUTejNkVFZXguo-s7l5ei2KIf7KqAiQKNKZ6BzLNuqDunaOZA8uvyAjtog
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<div class="grid__col--6 grid__col--lg12">
<div class="grid__col--12 contentpadding" style="margin-top:20px;">
<h1>Claim uw € 5 korting</h1>
<p>Vul de verjaardagskalender in en krijg direct € 5 korting op uw volgende artsenconsult. </p>
</div>
<div class="grid__row grid__row--inputspacer contentpadding">
<div class="grid__col--12 grid__col--sm12 grid__col--no-bottomspace">
<label placeholder="Naam" class="form__label required bold-label" for="contact_form_surname bold-label">Voornaam</label>
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<div class="grid__col--9 grid__col--sm12">
<div class="e-form__input">
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<div class="grid__col--12 grid__col--sm12 grid__col--no-bottomspace">
<label placeholder="Naam" class="form__label required bold-label" for="contact_form_surname bold-label">Achternaam</label>
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<div class="grid__col--9 grid__col--sm12">
<div class="e-form__input">
<input value="de neef" id="contact_form_surname" class="input-field" name="contact_form_surname" placeholder="" type="text">
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</div>
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<div class="grid__row grid__row--inputspacer contentpadding">
<div class="grid__col--12 grid__col--sm12 grid__col--no-bottomspace">
<label data-select-show="order-warning" data-select-id="15" class="form__label required bold-label">Geboortedatum</label>
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<div class="grid__col--3 grid__col--sm12">
<div class="e-form__dropdown">
<select class="combine input-field date-input" id="date" name="birthday_day" data-select-show="order-warning" data-select-id="15">
<option value="" selected="">dag</option>
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>
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</div>
<div class="grid__col--3 grid__col--sm12">
<div class="e-form__dropdown">
<select class="combine input-field date-input" id="month" name="birthday_month" data-select-show="order-warning" data-select-id="15">
<option value="" selected="">Maand</option>
<option value="1">Januari</option>
<option value="2">Februari</option>
<option value="3">Maart</option>
<option value="4">April</option>
<option value="5">Mei</option>
<option value="6">Juni</option>
<option value="7">Juli</option>
<option value="8">Augustus</option>
<option value="9">September</option>
<option value="10">Oktober</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
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<div class="grid__col--3 grid__col--sm12">
<div class="e-form__dropdown">
<select class="combine input-field date-input" id="year">
<option value="" selected="">Jaar</option>
<option value="2005">2005</option>
<option value="2004">2004</option>
<option value="2003">2003</option>
<option value="2002">2002</option>
<option value="2001">2001</option>
<option value="2000">2000</option>
<option value="1999">1999</option>
<option value="1998">1998</option>
<option value="1997">1997</option>
<option value="1996">1996</option>
<option value="1995">1995</option>
<option value="1994">1994</option>
<option value="1993">1993</option>
<option value="1992">1992</option>
<option value="1991">1991</option>
<option value="1990">1990</option>
<option value="1989">1989</option>
<option value="1988">1988</option>
<option value="1987">1987</option>
<option value="1986">1986</option>
<option value="1985">1985</option>
<option value="1984">1984</option>
<option value="1983">1983</option>
<option value="1982">1982</option>
<option value="1981">1981</option>
<option value="1980">1980</option>
<option value="1979">1979</option>
<option value="1978">1978</option>
<option value="1977">1977</option>
<option value="1976">1976</option>
<option value="1975">1975</option>
<option value="1974">1974</option>
<option value="1973">1973</option>
<option value="1972">1972</option>
<option value="1971">1971</option>
<option value="1970">1970</option>
<option value="1969">1969</option>
<option value="1968">1968</option>
<option value="1967">1967</option>
<option value="1966">1966</option>
<option value="1965">1965</option>
<option value="1964">1964</option>
<option value="1963">1963</option>
<option value="1962">1962</option>
<option value="1961">1961</option>
<option value="1960">1960</option>
<option value="1959">1959</option>
<option value="1958">1958</option>
<option value="1957">1957</option>
<option value="1956">1956</option>
<option value="1955">1955</option>
<option value="1954">1954</option>
<option value="1953">1953</option>
<option value="1952">1952</option>
<option value="1951">1951</option>
<option value="1950">1950</option>
<option value="1949">1949</option>
<option value="1948">1948</option>
<option value="1947">1947</option>
<option value="1946">1946</option>
<option value="1945">1945</option>
<option value="1944">1944</option>
<option value="1943">1943</option>
<option value="1942">1942</option>
<option value="1941">1941</option>
<option value="1940">1940</option>
<option value="1939">1939</option>
<option value="1938">1938</option>
<option value="1937">1937</option>
<option value="1936">1936</option>
<option value="1935">1935</option>
<option value="1934">1934</option>
<option value="1933">1933</option>
<option value="1932">1932</option>
<option value="1931">1931</option>
<option value="1930">1930</option>
<option value="1929">1929</option>
<option value="1928">1928</option>
<option value="1927">1927</option>
<option value="1926">1926</option>
<option value="1925">1925</option>
<option value="1924">1924</option>
<option value="1923">1923</option>
<option value="1922">1922</option>
<option value="1921">1921</option>
<option value="1920">1920</option>
<option value="1919">1919</option>
<option value="1918">1918</option>
<option value="1917">1917</option>
<option value="1916">1916</option>
<option value="1915">1915</option>
<option value="1914">1914</option>
<option value="1913">1913</option>
<option value="1912">1912</option>
<option value="1911">1911</option>
<option value="1910">1910</option>
<option value="1909">1909</option>
<option value="1908">1908</option>
<option value="1907">1907</option>
<option value="1906">1906</option>
<option value="1905">1905</option>
<option value="1904">1904</option>
<option value="1903">1903</option>
<option value="1902">1902</option>
<option value="1901">1901</option>
<option value="1900">1900</option>
</select>
</div>
</div>
<input value="" class="dob input-field" id="DOB" name="Dob" type="text">
<input value="" class="dob input-field" id="combined-date" name="combined-date" type="text">
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margin: 0 auto;
margin-bottom: 30px;
box-shadow: rgba(99, 99, 99, 0.2) 0px 2px 8px 0px;">
<img src="https://cdn.msdp1.com/public/Matchvertise/cb78ddfee7cd6e90aae7592cc11d13aa/Birthday-Invitation-backgroundwithlogo.png" alt="" width="" height="" style=" min-height: 488px;">
<div id="gif-container" style="width:100%;">
<img src="https://cdn.msdp1.com/public/Matchvertise/abfbd8eba9817a632db8516d1232adf8/giphy-v9.gif" class="m" style="margin:0 auto;">
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<div class="overlay-text" style="color:#343333; top: 50%;
left: 50%;
transform: translate(-50%, -50%);">
<!-- Div waar de voornaam wordt getoond -->
<div id="MnameOutput" class="">dimitri de neef</div>
<div id="Magecontainer">
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<div id="MleeftijdOutput" class="text-behind"></div>
<img src="https://cdn.msdp1.com/public/Matchvertise/cb78ddfee7cd6e90aae7592cc11d13aa/Horizontaal-birthday-cake_%281%29.png" style="
width: 70%;
height: 70%;
" alt="" width="" height="" id="Mcake" class="transparent-image">
</div>
<!-- Div waar de date wordt getoond -->
<div id="MdateOutput" class=""> </div>
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<button type="submit" id="form_submit" name="form_submit" class="button" style="width:auto!important;">Claim uw € 5 korting</button><br>
<div><br>
</div>
</div>
</div>
</div>
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<div class="card_up image-container" style="height:738px;">
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<div class="overlay-text" style="color:#343333">
<div class="curved-text" style=" visibility: hidden; margin-top: 40px;">
<svg width="500" height="100" xmlns="http://www.w3.org/2000/svg">
<!-- Definieer het cirkelpad. Dit blijft onzichtbaar -->
<path id="curve" d="M10 200 Q 250 -100 490 200" fill="transparent"></path>
<!-- Plaats tekst op het pad -->
<text font-size="12">
<textPath href="#curve" startOffset="35%" style=" color: #343333;
letter-spacing: 3px;
">DIT JAAR WORDT JIJ </textPath>
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<!-- Div waar de voornaam wordt getoond -->
<div id="nameOutput" class="">dimitri de neef</div>
<div id="agecontainer">
<!-- Div waar de leeftijd wordt getoond -->
<div id="leeftijdOutput" class="text-behind"></div>
<img src="https://cdn.msdp1.com/public/Matchvertise/cb78ddfee7cd6e90aae7592cc11d13aa/Horizontaal-birthday-cake_%281%29.png" style="
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<div class="line" style="display:none;margin-top:0px;"><img src="https://cdn.msdp1.com/public/Matchvertise/cb78ddfee7cd6e90aae7592cc11d13aa/Verticaal-line.png" alt="" width="" height="" style="width: 350px;
margin: 0 auto;"></div>
<!-- Div waar de date wordt getoond -->
<div id="dateOutput" class=""> </div>
<div class="line" style="display:none;"><img src="https://cdn.msdp1.com/public/Matchvertise/cb78ddfee7cd6e90aae7592cc11d13aa/Verticaal-line.png" alt="" width="" height="" style="width: 350px;
margin: 0 auto;"></div>
</div>
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position: absolute;
bottom: 15px;
left: 50%;
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width: 145px;
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<p> </p>
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22 * Betrouwbaar & Veilig * Eenvoudig & Snel * Discreet & Verantwoord * Hoge klanttevredenheid Bekijk alle behandelingen Intro-BirthdayP1 - nl-be BirthdayCard - nl-be DIT JAAR WORDT JIJ CLAIM UW € 5 KORTING Vul de verjaardagskalender in en krijg direct € 5 korting op uw volgende artsenconsult. Voornaam Achternaam Geboortedatum dag 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Maand Januari Februari Maart April Mei Juni Juli Augustus September Oktober November December Jaar 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900 dimitri de neef Claim uw € 5 korting DIT JAAR WORDT JIJ dimitri de neef Directe bankoverschrijving Privacy Algemene voorwaarden Cookies © 2023 Dokteronline. Alle rechten voorbehouden. Alle handelsmerken en geregistreerde merken zijn eigendom van hun respectieve bedrijven. Niets op deze website is een aanbod door of namens Dokteronline. Dokteronline is geen online apotheek of online dokter, maar biedt uitsluitend een informatieve en facilitaire service. De website www.dokteronline.com wordt geëxploiteerd door eMedvertise N.V., Willemstad (Curaçao). Betalingen geschieden via Health Rock Ltd, Londen (Verenigd Koninkrijk), registratie nummer 09056454.