espace-coaching.ch
Open in
urlscan Pro
2001:1600:4:13:d294:66ff:fe0e:a4d4
Public Scan
URL:
https://espace-coaching.ch/
Submission: On November 07 via api from CH — Scanned from CH
Submission: On November 07 via api from CH — Scanned from CH
Form analysis 2 forms found in the DOM
POST /
<form id="wpforms-form-28835" class="wpforms-validate wpforms-form wpforms-ajax-form" data-formid="28835" method="post" enctype="multipart/form-data" action="/" data-token="eb7306f1728abc8df808f973b3ec7bbd" data-token-time="1730953094"
novalidate="novalidate"><noscript class="wpforms-error-noscript">Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen.</noscript>
<div class="wpforms-hidden" id="wpforms-error-noscript">Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen.</div>
<div class="wpforms-page-indicator progress" data-indicator="progress" data-indicator-color="#066aab" data-scroll="1" role="progressbar" aria-valuenow="1" aria-valuemin="1" aria-valuemax="4" tabindex="-1"><span
class="wpforms-page-indicator-page-title"></span><span class="wpforms-page-indicator-page-title-sep" style="display:none;"> - </span><span class="wpforms-page-indicator-steps">Schritt <span class="wpforms-page-indicator-steps-current">1</span>
von 4</span>
<div class="wpforms-page-indicator-page-progress-wrap">
<div class="wpforms-page-indicator-page-progress" style="width:25%;background-color:#066aab"></div>
</div>
</div>
<div class="wpforms-field-container">
<div class="wpforms-page wpforms-page-1 " data-page="1">
<div id="wpforms-28835-field_14-container" class="wpforms-field wpforms-field-pagebreak" data-field-id="14"></div>
<div id="wpforms-28835-field_78-container" class="wpforms-field wpforms-field-content" data-field-id="78">
<div id="wpforms-28835-field_78" class="wpforms-field-medium wpforms-field-row" aria-errormessage="wpforms-28835-field_78-error">
<p>Damit wir möglichst bald mit dem Coaching starten können, brauche ich zuerst Informationen zu Ihrem aktuellen Gesundheitszustand und Lebensstil.</p>
<p>Bitte füllen Sie diesen Fragebogen bis 24 Stunden vor dem Erstgespräch aus. Das Formular kann in mehreren Sessions ausgefüllt werden, die von Ihnen eingegeben Daten werden dann auf den Servern der espace Health Gesundheitszentren AG
zwischengespeichert.</p>
<p><strong>Scrollen Sie bis ans Ende des Formulars, um Ihre Angaben zwischenzuspeichern.</strong></p>
<p>Mit diesen Antworten können wir speditiv gemeinsam ins Coaching starten. Herzlichen Dank für's zeitgerechte Ausfüllen, ich freue mich sehr auf Sie!</p>
<div class="wpforms-field-content-display-frontend-clear"></div>
</div>
</div>
<div id="wpforms-28835-field_7-container" class="wpforms-field wpforms-field-divider" data-field-id="7">
<h3 id="wpforms-28835-field_7" aria-errormessage="wpforms-28835-field_7-error">Personendaten</h3>
</div>
<div id="wpforms-28835-field_2-container" class="wpforms-field wpforms-field-text" data-field-id="2"><label class="wpforms-field-label" for="wpforms-28835-field_2">Wie lautet Ihr Vor- und Nachname? <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="text" id="wpforms-28835-field_2" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][2]" aria-errormessage="wpforms-28835-field_2-error" required=""></div>
<div id="wpforms-28835-field_5-container" class="wpforms-field wpforms-field-phone" data-field-id="5"><label class="wpforms-field-label" for="wpforms-28835-field_5">Bitte geben Sie Ihre Telefonnummer an <span class="wpforms-required-label"
aria-hidden="true">*</span></label>
<div class="iti iti--allow-dropdown iti--show-flags iti--inline-dropdown">
<div class="iti__country-container"><button type="button" class="iti__selected-country" aria-expanded="false" aria-label="Selected country" aria-haspopup="listbox" aria-controls="iti-2__country-listbox" tabindex="0"
title="United States: +1">
<div class="iti__flag iti__us"><span class="iti__a11y-text">United States +1</span></div>
<div class="iti__arrow" aria-hidden="true"></div>
</button>
<div id="iti-2__dropdown-content" class="iti__dropdown-content iti__hide iti--flexible-dropdown-width">
<ul class="iti__country-list" id="iti-2__country-listbox" role="listbox" aria-label="List of countries">
<li id="iti-2__item-us-preferred" class="iti__country iti__preferred iti__active" tabindex="-1" role="option" data-dial-code="1" data-country-code="us" aria-selected="true">
<div class="iti__flag-box">
<div class="iti__flag iti__us"></div>
</div><span class="iti__country-name">United States</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-gb-preferred" class="iti__country iti__preferred" tabindex="-1" role="option" data-dial-code="44" data-country-code="gb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gb"></div>
</div><span class="iti__country-name">United Kingdom</span><span class="iti__dial-code">+44</span>
</li>
<li class="iti__divider" aria-hidden="true"></li>
<li id="iti-2__item-af" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="93" data-country-code="af" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__af"></div>
</div><span class="iti__country-name">Afghanistan</span><span class="iti__dial-code">+93</span>
</li>
<li id="iti-2__item-al" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="355" data-country-code="al" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__al"></div>
</div><span class="iti__country-name">Albania</span><span class="iti__dial-code">+355</span>
</li>
<li id="iti-2__item-dz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="213" data-country-code="dz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__dz"></div>
</div><span class="iti__country-name">Algeria</span><span class="iti__dial-code">+213</span>
</li>
<li id="iti-2__item-as" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="as" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__as"></div>
</div><span class="iti__country-name">American Samoa</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-ad" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="376" data-country-code="ad" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ad"></div>
</div><span class="iti__country-name">Andorra</span><span class="iti__dial-code">+376</span>
</li>
<li id="iti-2__item-ao" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="244" data-country-code="ao" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ao"></div>
</div><span class="iti__country-name">Angola</span><span class="iti__dial-code">+244</span>
</li>
<li id="iti-2__item-ai" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="ai" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ai"></div>
</div><span class="iti__country-name">Anguilla</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-ag" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="ag" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ag"></div>
</div><span class="iti__country-name">Antigua & Barbuda</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-ar" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="54" data-country-code="ar" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ar"></div>
</div><span class="iti__country-name">Argentina</span><span class="iti__dial-code">+54</span>
</li>
<li id="iti-2__item-am" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="374" data-country-code="am" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__am"></div>
</div><span class="iti__country-name">Armenia</span><span class="iti__dial-code">+374</span>
</li>
<li id="iti-2__item-aw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="297" data-country-code="aw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__aw"></div>
</div><span class="iti__country-name">Aruba</span><span class="iti__dial-code">+297</span>
</li>
<li id="iti-2__item-ac" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="247" data-country-code="ac" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ac"></div>
</div><span class="iti__country-name">Ascension Island</span><span class="iti__dial-code">+247</span>
</li>
<li id="iti-2__item-au" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="61" data-country-code="au" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__au"></div>
</div><span class="iti__country-name">Australia</span><span class="iti__dial-code">+61</span>
</li>
<li id="iti-2__item-at" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="43" data-country-code="at" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__at"></div>
</div><span class="iti__country-name">Austria</span><span class="iti__dial-code">+43</span>
</li>
<li id="iti-2__item-az" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="994" data-country-code="az" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__az"></div>
</div><span class="iti__country-name">Azerbaijan</span><span class="iti__dial-code">+994</span>
</li>
<li id="iti-2__item-bs" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="bs" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bs"></div>
</div><span class="iti__country-name">Bahamas</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-bh" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="973" data-country-code="bh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bh"></div>
</div><span class="iti__country-name">Bahrain</span><span class="iti__dial-code">+973</span>
</li>
<li id="iti-2__item-bd" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="880" data-country-code="bd" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bd"></div>
</div><span class="iti__country-name">Bangladesh</span><span class="iti__dial-code">+880</span>
</li>
<li id="iti-2__item-bb" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="bb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bb"></div>
</div><span class="iti__country-name">Barbados</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-by" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="375" data-country-code="by" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__by"></div>
</div><span class="iti__country-name">Belarus</span><span class="iti__dial-code">+375</span>
</li>
<li id="iti-2__item-be" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="32" data-country-code="be" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__be"></div>
</div><span class="iti__country-name">Belgium</span><span class="iti__dial-code">+32</span>
</li>
<li id="iti-2__item-bz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="501" data-country-code="bz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bz"></div>
</div><span class="iti__country-name">Belize</span><span class="iti__dial-code">+501</span>
</li>
<li id="iti-2__item-bj" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="229" data-country-code="bj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bj"></div>
</div><span class="iti__country-name">Benin</span><span class="iti__dial-code">+229</span>
</li>
<li id="iti-2__item-bm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="bm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bm"></div>
</div><span class="iti__country-name">Bermuda</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-bt" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="975" data-country-code="bt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bt"></div>
</div><span class="iti__country-name">Bhutan</span><span class="iti__dial-code">+975</span>
</li>
<li id="iti-2__item-bo" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="591" data-country-code="bo" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bo"></div>
</div><span class="iti__country-name">Bolivia</span><span class="iti__dial-code">+591</span>
</li>
<li id="iti-2__item-ba" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="387" data-country-code="ba" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ba"></div>
</div><span class="iti__country-name">Bosnia & Herzegovina</span><span class="iti__dial-code">+387</span>
</li>
<li id="iti-2__item-bw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="267" data-country-code="bw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bw"></div>
</div><span class="iti__country-name">Botswana</span><span class="iti__dial-code">+267</span>
</li>
<li id="iti-2__item-br" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="55" data-country-code="br" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__br"></div>
</div><span class="iti__country-name">Brazil</span><span class="iti__dial-code">+55</span>
</li>
<li id="iti-2__item-io" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="246" data-country-code="io" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__io"></div>
</div><span class="iti__country-name">British Indian Ocean Territory</span><span class="iti__dial-code">+246</span>
</li>
<li id="iti-2__item-vg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="vg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vg"></div>
</div><span class="iti__country-name">British Virgin Islands</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-bn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="673" data-country-code="bn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bn"></div>
</div><span class="iti__country-name">Brunei</span><span class="iti__dial-code">+673</span>
</li>
<li id="iti-2__item-bg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="359" data-country-code="bg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bg"></div>
</div><span class="iti__country-name">Bulgaria</span><span class="iti__dial-code">+359</span>
</li>
<li id="iti-2__item-bf" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="226" data-country-code="bf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bf"></div>
</div><span class="iti__country-name">Burkina Faso</span><span class="iti__dial-code">+226</span>
</li>
<li id="iti-2__item-bi" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="257" data-country-code="bi" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bi"></div>
</div><span class="iti__country-name">Burundi</span><span class="iti__dial-code">+257</span>
</li>
<li id="iti-2__item-kh" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="855" data-country-code="kh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kh"></div>
</div><span class="iti__country-name">Cambodia</span><span class="iti__dial-code">+855</span>
</li>
<li id="iti-2__item-cm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="237" data-country-code="cm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cm"></div>
</div><span class="iti__country-name">Cameroon</span><span class="iti__dial-code">+237</span>
</li>
<li id="iti-2__item-ca" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="ca" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ca"></div>
</div><span class="iti__country-name">Canada</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-cv" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="238" data-country-code="cv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cv"></div>
</div><span class="iti__country-name">Cape Verde</span><span class="iti__dial-code">+238</span>
</li>
<li id="iti-2__item-bq" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="599" data-country-code="bq" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bq"></div>
</div><span class="iti__country-name">Caribbean Netherlands</span><span class="iti__dial-code">+599</span>
</li>
<li id="iti-2__item-ky" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="ky" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ky"></div>
</div><span class="iti__country-name">Cayman Islands</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-cf" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="236" data-country-code="cf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cf"></div>
</div><span class="iti__country-name">Central African Republic</span><span class="iti__dial-code">+236</span>
</li>
<li id="iti-2__item-td" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="235" data-country-code="td" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__td"></div>
</div><span class="iti__country-name">Chad</span><span class="iti__dial-code">+235</span>
</li>
<li id="iti-2__item-cl" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="56" data-country-code="cl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cl"></div>
</div><span class="iti__country-name">Chile</span><span class="iti__dial-code">+56</span>
</li>
<li id="iti-2__item-cn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="86" data-country-code="cn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cn"></div>
</div><span class="iti__country-name">China</span><span class="iti__dial-code">+86</span>
</li>
<li id="iti-2__item-cx" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="61" data-country-code="cx" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cx"></div>
</div><span class="iti__country-name">Christmas Island</span><span class="iti__dial-code">+61</span>
</li>
<li id="iti-2__item-cc" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="61" data-country-code="cc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cc"></div>
</div><span class="iti__country-name">Cocos (Keeling) Islands</span><span class="iti__dial-code">+61</span>
</li>
<li id="iti-2__item-co" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="57" data-country-code="co" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__co"></div>
</div><span class="iti__country-name">Colombia</span><span class="iti__dial-code">+57</span>
</li>
<li id="iti-2__item-km" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="269" data-country-code="km" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__km"></div>
</div><span class="iti__country-name">Comoros</span><span class="iti__dial-code">+269</span>
</li>
<li id="iti-2__item-cg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="242" data-country-code="cg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cg"></div>
</div><span class="iti__country-name">Congo - Brazzaville</span><span class="iti__dial-code">+242</span>
</li>
<li id="iti-2__item-cd" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="243" data-country-code="cd" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cd"></div>
</div><span class="iti__country-name">Congo - Kinshasa</span><span class="iti__dial-code">+243</span>
</li>
<li id="iti-2__item-ck" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="682" data-country-code="ck" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ck"></div>
</div><span class="iti__country-name">Cook Islands</span><span class="iti__dial-code">+682</span>
</li>
<li id="iti-2__item-cr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="506" data-country-code="cr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cr"></div>
</div><span class="iti__country-name">Costa Rica</span><span class="iti__dial-code">+506</span>
</li>
<li id="iti-2__item-hr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="385" data-country-code="hr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__hr"></div>
</div><span class="iti__country-name">Croatia</span><span class="iti__dial-code">+385</span>
</li>
<li id="iti-2__item-cu" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="53" data-country-code="cu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cu"></div>
</div><span class="iti__country-name">Cuba</span><span class="iti__dial-code">+53</span>
</li>
<li id="iti-2__item-cw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="599" data-country-code="cw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cw"></div>
</div><span class="iti__country-name">Curaçao</span><span class="iti__dial-code">+599</span>
</li>
<li id="iti-2__item-cy" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="357" data-country-code="cy" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cy"></div>
</div><span class="iti__country-name">Cyprus</span><span class="iti__dial-code">+357</span>
</li>
<li id="iti-2__item-cz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="420" data-country-code="cz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__cz"></div>
</div><span class="iti__country-name">Czechia</span><span class="iti__dial-code">+420</span>
</li>
<li id="iti-2__item-ci" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="225" data-country-code="ci" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ci"></div>
</div><span class="iti__country-name">Côte d’Ivoire</span><span class="iti__dial-code">+225</span>
</li>
<li id="iti-2__item-dk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="45" data-country-code="dk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__dk"></div>
</div><span class="iti__country-name">Denmark</span><span class="iti__dial-code">+45</span>
</li>
<li id="iti-2__item-dj" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="253" data-country-code="dj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__dj"></div>
</div><span class="iti__country-name">Djibouti</span><span class="iti__dial-code">+253</span>
</li>
<li id="iti-2__item-dm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="dm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__dm"></div>
</div><span class="iti__country-name">Dominica</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-do" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="do" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__do"></div>
</div><span class="iti__country-name">Dominican Republic</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-ec" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="593" data-country-code="ec" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ec"></div>
</div><span class="iti__country-name">Ecuador</span><span class="iti__dial-code">+593</span>
</li>
<li id="iti-2__item-eg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="20" data-country-code="eg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__eg"></div>
</div><span class="iti__country-name">Egypt</span><span class="iti__dial-code">+20</span>
</li>
<li id="iti-2__item-sv" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="503" data-country-code="sv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sv"></div>
</div><span class="iti__country-name">El Salvador</span><span class="iti__dial-code">+503</span>
</li>
<li id="iti-2__item-gq" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="240" data-country-code="gq" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gq"></div>
</div><span class="iti__country-name">Equatorial Guinea</span><span class="iti__dial-code">+240</span>
</li>
<li id="iti-2__item-er" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="291" data-country-code="er" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__er"></div>
</div><span class="iti__country-name">Eritrea</span><span class="iti__dial-code">+291</span>
</li>
<li id="iti-2__item-ee" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="372" data-country-code="ee" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ee"></div>
</div><span class="iti__country-name">Estonia</span><span class="iti__dial-code">+372</span>
</li>
<li id="iti-2__item-sz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="268" data-country-code="sz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sz"></div>
</div><span class="iti__country-name">Eswatini</span><span class="iti__dial-code">+268</span>
</li>
<li id="iti-2__item-et" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="251" data-country-code="et" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__et"></div>
</div><span class="iti__country-name">Ethiopia</span><span class="iti__dial-code">+251</span>
</li>
<li id="iti-2__item-fk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="500" data-country-code="fk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fk"></div>
</div><span class="iti__country-name">Falkland Islands</span><span class="iti__dial-code">+500</span>
</li>
<li id="iti-2__item-fo" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="298" data-country-code="fo" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fo"></div>
</div><span class="iti__country-name">Faroe Islands</span><span class="iti__dial-code">+298</span>
</li>
<li id="iti-2__item-fj" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="679" data-country-code="fj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fj"></div>
</div><span class="iti__country-name">Fiji</span><span class="iti__dial-code">+679</span>
</li>
<li id="iti-2__item-fi" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="358" data-country-code="fi" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fi"></div>
</div><span class="iti__country-name">Finland</span><span class="iti__dial-code">+358</span>
</li>
<li id="iti-2__item-fr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="33" data-country-code="fr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fr"></div>
</div><span class="iti__country-name">France</span><span class="iti__dial-code">+33</span>
</li>
<li id="iti-2__item-gf" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="594" data-country-code="gf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gf"></div>
</div><span class="iti__country-name">French Guiana</span><span class="iti__dial-code">+594</span>
</li>
<li id="iti-2__item-pf" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="689" data-country-code="pf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pf"></div>
</div><span class="iti__country-name">French Polynesia</span><span class="iti__dial-code">+689</span>
</li>
<li id="iti-2__item-ga" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="241" data-country-code="ga" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ga"></div>
</div><span class="iti__country-name">Gabon</span><span class="iti__dial-code">+241</span>
</li>
<li id="iti-2__item-gm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="220" data-country-code="gm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gm"></div>
</div><span class="iti__country-name">Gambia</span><span class="iti__dial-code">+220</span>
</li>
<li id="iti-2__item-ge" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="995" data-country-code="ge" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ge"></div>
</div><span class="iti__country-name">Georgia</span><span class="iti__dial-code">+995</span>
</li>
<li id="iti-2__item-de" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="49" data-country-code="de" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__de"></div>
</div><span class="iti__country-name">Germany</span><span class="iti__dial-code">+49</span>
</li>
<li id="iti-2__item-gh" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="233" data-country-code="gh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gh"></div>
</div><span class="iti__country-name">Ghana</span><span class="iti__dial-code">+233</span>
</li>
<li id="iti-2__item-gi" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="350" data-country-code="gi" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gi"></div>
</div><span class="iti__country-name">Gibraltar</span><span class="iti__dial-code">+350</span>
</li>
<li id="iti-2__item-gr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="30" data-country-code="gr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gr"></div>
</div><span class="iti__country-name">Greece</span><span class="iti__dial-code">+30</span>
</li>
<li id="iti-2__item-gl" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="299" data-country-code="gl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gl"></div>
</div><span class="iti__country-name">Greenland</span><span class="iti__dial-code">+299</span>
</li>
<li id="iti-2__item-gd" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="gd" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gd"></div>
</div><span class="iti__country-name">Grenada</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-gp" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="590" data-country-code="gp" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gp"></div>
</div><span class="iti__country-name">Guadeloupe</span><span class="iti__dial-code">+590</span>
</li>
<li id="iti-2__item-gu" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="gu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gu"></div>
</div><span class="iti__country-name">Guam</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-gt" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="502" data-country-code="gt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gt"></div>
</div><span class="iti__country-name">Guatemala</span><span class="iti__dial-code">+502</span>
</li>
<li id="iti-2__item-gg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="44" data-country-code="gg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gg"></div>
</div><span class="iti__country-name">Guernsey</span><span class="iti__dial-code">+44</span>
</li>
<li id="iti-2__item-gn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="224" data-country-code="gn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gn"></div>
</div><span class="iti__country-name">Guinea</span><span class="iti__dial-code">+224</span>
</li>
<li id="iti-2__item-gw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="245" data-country-code="gw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gw"></div>
</div><span class="iti__country-name">Guinea-Bissau</span><span class="iti__dial-code">+245</span>
</li>
<li id="iti-2__item-gy" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="592" data-country-code="gy" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gy"></div>
</div><span class="iti__country-name">Guyana</span><span class="iti__dial-code">+592</span>
</li>
<li id="iti-2__item-ht" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="509" data-country-code="ht" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ht"></div>
</div><span class="iti__country-name">Haiti</span><span class="iti__dial-code">+509</span>
</li>
<li id="iti-2__item-hn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="504" data-country-code="hn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__hn"></div>
</div><span class="iti__country-name">Honduras</span><span class="iti__dial-code">+504</span>
</li>
<li id="iti-2__item-hk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="852" data-country-code="hk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__hk"></div>
</div><span class="iti__country-name">Hong Kong SAR China</span><span class="iti__dial-code">+852</span>
</li>
<li id="iti-2__item-hu" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="36" data-country-code="hu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__hu"></div>
</div><span class="iti__country-name">Hungary</span><span class="iti__dial-code">+36</span>
</li>
<li id="iti-2__item-is" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="354" data-country-code="is" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__is"></div>
</div><span class="iti__country-name">Iceland</span><span class="iti__dial-code">+354</span>
</li>
<li id="iti-2__item-in" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="91" data-country-code="in" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__in"></div>
</div><span class="iti__country-name">India</span><span class="iti__dial-code">+91</span>
</li>
<li id="iti-2__item-id" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="62" data-country-code="id" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__id"></div>
</div><span class="iti__country-name">Indonesia</span><span class="iti__dial-code">+62</span>
</li>
<li id="iti-2__item-ir" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="98" data-country-code="ir" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ir"></div>
</div><span class="iti__country-name">Iran</span><span class="iti__dial-code">+98</span>
</li>
<li id="iti-2__item-iq" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="964" data-country-code="iq" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__iq"></div>
</div><span class="iti__country-name">Iraq</span><span class="iti__dial-code">+964</span>
</li>
<li id="iti-2__item-ie" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="353" data-country-code="ie" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ie"></div>
</div><span class="iti__country-name">Ireland</span><span class="iti__dial-code">+353</span>
</li>
<li id="iti-2__item-im" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="44" data-country-code="im" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__im"></div>
</div><span class="iti__country-name">Isle of Man</span><span class="iti__dial-code">+44</span>
</li>
<li id="iti-2__item-il" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="972" data-country-code="il" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__il"></div>
</div><span class="iti__country-name">Israel</span><span class="iti__dial-code">+972</span>
</li>
<li id="iti-2__item-it" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="39" data-country-code="it" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__it"></div>
</div><span class="iti__country-name">Italy</span><span class="iti__dial-code">+39</span>
</li>
<li id="iti-2__item-jm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="jm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__jm"></div>
</div><span class="iti__country-name">Jamaica</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-jp" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="81" data-country-code="jp" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__jp"></div>
</div><span class="iti__country-name">Japan</span><span class="iti__dial-code">+81</span>
</li>
<li id="iti-2__item-je" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="44" data-country-code="je" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__je"></div>
</div><span class="iti__country-name">Jersey</span><span class="iti__dial-code">+44</span>
</li>
<li id="iti-2__item-jo" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="962" data-country-code="jo" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__jo"></div>
</div><span class="iti__country-name">Jordan</span><span class="iti__dial-code">+962</span>
</li>
<li id="iti-2__item-kz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="7" data-country-code="kz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kz"></div>
</div><span class="iti__country-name">Kazakhstan</span><span class="iti__dial-code">+7</span>
</li>
<li id="iti-2__item-ke" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="254" data-country-code="ke" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ke"></div>
</div><span class="iti__country-name">Kenya</span><span class="iti__dial-code">+254</span>
</li>
<li id="iti-2__item-ki" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="686" data-country-code="ki" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ki"></div>
</div><span class="iti__country-name">Kiribati</span><span class="iti__dial-code">+686</span>
</li>
<li id="iti-2__item-xk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="383" data-country-code="xk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__xk"></div>
</div><span class="iti__country-name">Kosovo</span><span class="iti__dial-code">+383</span>
</li>
<li id="iti-2__item-kw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="965" data-country-code="kw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kw"></div>
</div><span class="iti__country-name">Kuwait</span><span class="iti__dial-code">+965</span>
</li>
<li id="iti-2__item-kg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="996" data-country-code="kg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kg"></div>
</div><span class="iti__country-name">Kyrgyzstan</span><span class="iti__dial-code">+996</span>
</li>
<li id="iti-2__item-la" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="856" data-country-code="la" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__la"></div>
</div><span class="iti__country-name">Laos</span><span class="iti__dial-code">+856</span>
</li>
<li id="iti-2__item-lv" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="371" data-country-code="lv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lv"></div>
</div><span class="iti__country-name">Latvia</span><span class="iti__dial-code">+371</span>
</li>
<li id="iti-2__item-lb" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="961" data-country-code="lb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lb"></div>
</div><span class="iti__country-name">Lebanon</span><span class="iti__dial-code">+961</span>
</li>
<li id="iti-2__item-ls" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="266" data-country-code="ls" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ls"></div>
</div><span class="iti__country-name">Lesotho</span><span class="iti__dial-code">+266</span>
</li>
<li id="iti-2__item-lr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="231" data-country-code="lr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lr"></div>
</div><span class="iti__country-name">Liberia</span><span class="iti__dial-code">+231</span>
</li>
<li id="iti-2__item-ly" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="218" data-country-code="ly" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ly"></div>
</div><span class="iti__country-name">Libya</span><span class="iti__dial-code">+218</span>
</li>
<li id="iti-2__item-li" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="423" data-country-code="li" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__li"></div>
</div><span class="iti__country-name">Liechtenstein</span><span class="iti__dial-code">+423</span>
</li>
<li id="iti-2__item-lt" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="370" data-country-code="lt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lt"></div>
</div><span class="iti__country-name">Lithuania</span><span class="iti__dial-code">+370</span>
</li>
<li id="iti-2__item-lu" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="352" data-country-code="lu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lu"></div>
</div><span class="iti__country-name">Luxembourg</span><span class="iti__dial-code">+352</span>
</li>
<li id="iti-2__item-mo" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="853" data-country-code="mo" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mo"></div>
</div><span class="iti__country-name">Macao SAR China</span><span class="iti__dial-code">+853</span>
</li>
<li id="iti-2__item-mg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="261" data-country-code="mg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mg"></div>
</div><span class="iti__country-name">Madagascar</span><span class="iti__dial-code">+261</span>
</li>
<li id="iti-2__item-mw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="265" data-country-code="mw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mw"></div>
</div><span class="iti__country-name">Malawi</span><span class="iti__dial-code">+265</span>
</li>
<li id="iti-2__item-my" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="60" data-country-code="my" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__my"></div>
</div><span class="iti__country-name">Malaysia</span><span class="iti__dial-code">+60</span>
</li>
<li id="iti-2__item-mv" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="960" data-country-code="mv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mv"></div>
</div><span class="iti__country-name">Maldives</span><span class="iti__dial-code">+960</span>
</li>
<li id="iti-2__item-ml" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="223" data-country-code="ml" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ml"></div>
</div><span class="iti__country-name">Mali</span><span class="iti__dial-code">+223</span>
</li>
<li id="iti-2__item-mt" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="356" data-country-code="mt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mt"></div>
</div><span class="iti__country-name">Malta</span><span class="iti__dial-code">+356</span>
</li>
<li id="iti-2__item-mh" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="692" data-country-code="mh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mh"></div>
</div><span class="iti__country-name">Marshall Islands</span><span class="iti__dial-code">+692</span>
</li>
<li id="iti-2__item-mq" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="596" data-country-code="mq" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mq"></div>
</div><span class="iti__country-name">Martinique</span><span class="iti__dial-code">+596</span>
</li>
<li id="iti-2__item-mr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="222" data-country-code="mr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mr"></div>
</div><span class="iti__country-name">Mauritania</span><span class="iti__dial-code">+222</span>
</li>
<li id="iti-2__item-mu" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="230" data-country-code="mu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mu"></div>
</div><span class="iti__country-name">Mauritius</span><span class="iti__dial-code">+230</span>
</li>
<li id="iti-2__item-yt" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="262" data-country-code="yt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__yt"></div>
</div><span class="iti__country-name">Mayotte</span><span class="iti__dial-code">+262</span>
</li>
<li id="iti-2__item-mx" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="52" data-country-code="mx" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mx"></div>
</div><span class="iti__country-name">Mexico</span><span class="iti__dial-code">+52</span>
</li>
<li id="iti-2__item-fm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="691" data-country-code="fm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__fm"></div>
</div><span class="iti__country-name">Micronesia</span><span class="iti__dial-code">+691</span>
</li>
<li id="iti-2__item-md" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="373" data-country-code="md" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__md"></div>
</div><span class="iti__country-name">Moldova</span><span class="iti__dial-code">+373</span>
</li>
<li id="iti-2__item-mc" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="377" data-country-code="mc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mc"></div>
</div><span class="iti__country-name">Monaco</span><span class="iti__dial-code">+377</span>
</li>
<li id="iti-2__item-mn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="976" data-country-code="mn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mn"></div>
</div><span class="iti__country-name">Mongolia</span><span class="iti__dial-code">+976</span>
</li>
<li id="iti-2__item-me" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="382" data-country-code="me" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__me"></div>
</div><span class="iti__country-name">Montenegro</span><span class="iti__dial-code">+382</span>
</li>
<li id="iti-2__item-ms" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="ms" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ms"></div>
</div><span class="iti__country-name">Montserrat</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-ma" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="212" data-country-code="ma" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ma"></div>
</div><span class="iti__country-name">Morocco</span><span class="iti__dial-code">+212</span>
</li>
<li id="iti-2__item-mz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="258" data-country-code="mz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mz"></div>
</div><span class="iti__country-name">Mozambique</span><span class="iti__dial-code">+258</span>
</li>
<li id="iti-2__item-mm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="95" data-country-code="mm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mm"></div>
</div><span class="iti__country-name">Myanmar (Burma)</span><span class="iti__dial-code">+95</span>
</li>
<li id="iti-2__item-na" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="264" data-country-code="na" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__na"></div>
</div><span class="iti__country-name">Namibia</span><span class="iti__dial-code">+264</span>
</li>
<li id="iti-2__item-nr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="674" data-country-code="nr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nr"></div>
</div><span class="iti__country-name">Nauru</span><span class="iti__dial-code">+674</span>
</li>
<li id="iti-2__item-np" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="977" data-country-code="np" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__np"></div>
</div><span class="iti__country-name">Nepal</span><span class="iti__dial-code">+977</span>
</li>
<li id="iti-2__item-nl" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="31" data-country-code="nl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nl"></div>
</div><span class="iti__country-name">Netherlands</span><span class="iti__dial-code">+31</span>
</li>
<li id="iti-2__item-nc" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="687" data-country-code="nc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nc"></div>
</div><span class="iti__country-name">New Caledonia</span><span class="iti__dial-code">+687</span>
</li>
<li id="iti-2__item-nz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="64" data-country-code="nz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nz"></div>
</div><span class="iti__country-name">New Zealand</span><span class="iti__dial-code">+64</span>
</li>
<li id="iti-2__item-ni" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="505" data-country-code="ni" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ni"></div>
</div><span class="iti__country-name">Nicaragua</span><span class="iti__dial-code">+505</span>
</li>
<li id="iti-2__item-ne" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="227" data-country-code="ne" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ne"></div>
</div><span class="iti__country-name">Niger</span><span class="iti__dial-code">+227</span>
</li>
<li id="iti-2__item-ng" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="234" data-country-code="ng" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ng"></div>
</div><span class="iti__country-name">Nigeria</span><span class="iti__dial-code">+234</span>
</li>
<li id="iti-2__item-nu" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="683" data-country-code="nu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nu"></div>
</div><span class="iti__country-name">Niue</span><span class="iti__dial-code">+683</span>
</li>
<li id="iti-2__item-nf" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="672" data-country-code="nf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__nf"></div>
</div><span class="iti__country-name">Norfolk Island</span><span class="iti__dial-code">+672</span>
</li>
<li id="iti-2__item-kp" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="850" data-country-code="kp" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kp"></div>
</div><span class="iti__country-name">North Korea</span><span class="iti__dial-code">+850</span>
</li>
<li id="iti-2__item-mk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="389" data-country-code="mk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mk"></div>
</div><span class="iti__country-name">North Macedonia</span><span class="iti__dial-code">+389</span>
</li>
<li id="iti-2__item-mp" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="mp" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mp"></div>
</div><span class="iti__country-name">Northern Mariana Islands</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-no" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="47" data-country-code="no" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__no"></div>
</div><span class="iti__country-name">Norway</span><span class="iti__dial-code">+47</span>
</li>
<li id="iti-2__item-om" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="968" data-country-code="om" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__om"></div>
</div><span class="iti__country-name">Oman</span><span class="iti__dial-code">+968</span>
</li>
<li id="iti-2__item-pk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="92" data-country-code="pk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pk"></div>
</div><span class="iti__country-name">Pakistan</span><span class="iti__dial-code">+92</span>
</li>
<li id="iti-2__item-pw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="680" data-country-code="pw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pw"></div>
</div><span class="iti__country-name">Palau</span><span class="iti__dial-code">+680</span>
</li>
<li id="iti-2__item-ps" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="970" data-country-code="ps" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ps"></div>
</div><span class="iti__country-name">Palestinian Territories</span><span class="iti__dial-code">+970</span>
</li>
<li id="iti-2__item-pa" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="507" data-country-code="pa" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pa"></div>
</div><span class="iti__country-name">Panama</span><span class="iti__dial-code">+507</span>
</li>
<li id="iti-2__item-pg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="675" data-country-code="pg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pg"></div>
</div><span class="iti__country-name">Papua New Guinea</span><span class="iti__dial-code">+675</span>
</li>
<li id="iti-2__item-py" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="595" data-country-code="py" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__py"></div>
</div><span class="iti__country-name">Paraguay</span><span class="iti__dial-code">+595</span>
</li>
<li id="iti-2__item-pe" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="51" data-country-code="pe" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pe"></div>
</div><span class="iti__country-name">Peru</span><span class="iti__dial-code">+51</span>
</li>
<li id="iti-2__item-ph" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="63" data-country-code="ph" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ph"></div>
</div><span class="iti__country-name">Philippines</span><span class="iti__dial-code">+63</span>
</li>
<li id="iti-2__item-pl" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="48" data-country-code="pl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pl"></div>
</div><span class="iti__country-name">Poland</span><span class="iti__dial-code">+48</span>
</li>
<li id="iti-2__item-pt" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="351" data-country-code="pt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pt"></div>
</div><span class="iti__country-name">Portugal</span><span class="iti__dial-code">+351</span>
</li>
<li id="iti-2__item-pr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="pr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pr"></div>
</div><span class="iti__country-name">Puerto Rico</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-qa" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="974" data-country-code="qa" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__qa"></div>
</div><span class="iti__country-name">Qatar</span><span class="iti__dial-code">+974</span>
</li>
<li id="iti-2__item-ro" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="40" data-country-code="ro" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ro"></div>
</div><span class="iti__country-name">Romania</span><span class="iti__dial-code">+40</span>
</li>
<li id="iti-2__item-ru" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="7" data-country-code="ru" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ru"></div>
</div><span class="iti__country-name">Russia</span><span class="iti__dial-code">+7</span>
</li>
<li id="iti-2__item-rw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="250" data-country-code="rw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__rw"></div>
</div><span class="iti__country-name">Rwanda</span><span class="iti__dial-code">+250</span>
</li>
<li id="iti-2__item-re" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="262" data-country-code="re" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__re"></div>
</div><span class="iti__country-name">Réunion</span><span class="iti__dial-code">+262</span>
</li>
<li id="iti-2__item-ws" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="685" data-country-code="ws" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ws"></div>
</div><span class="iti__country-name">Samoa</span><span class="iti__dial-code">+685</span>
</li>
<li id="iti-2__item-sm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="378" data-country-code="sm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sm"></div>
</div><span class="iti__country-name">San Marino</span><span class="iti__dial-code">+378</span>
</li>
<li id="iti-2__item-sa" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="966" data-country-code="sa" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sa"></div>
</div><span class="iti__country-name">Saudi Arabia</span><span class="iti__dial-code">+966</span>
</li>
<li id="iti-2__item-sn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="221" data-country-code="sn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sn"></div>
</div><span class="iti__country-name">Senegal</span><span class="iti__dial-code">+221</span>
</li>
<li id="iti-2__item-rs" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="381" data-country-code="rs" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__rs"></div>
</div><span class="iti__country-name">Serbia</span><span class="iti__dial-code">+381</span>
</li>
<li id="iti-2__item-sc" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="248" data-country-code="sc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sc"></div>
</div><span class="iti__country-name">Seychelles</span><span class="iti__dial-code">+248</span>
</li>
<li id="iti-2__item-sl" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="232" data-country-code="sl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sl"></div>
</div><span class="iti__country-name">Sierra Leone</span><span class="iti__dial-code">+232</span>
</li>
<li id="iti-2__item-sg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="65" data-country-code="sg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sg"></div>
</div><span class="iti__country-name">Singapore</span><span class="iti__dial-code">+65</span>
</li>
<li id="iti-2__item-sx" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="sx" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sx"></div>
</div><span class="iti__country-name">Sint Maarten</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-sk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="421" data-country-code="sk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sk"></div>
</div><span class="iti__country-name">Slovakia</span><span class="iti__dial-code">+421</span>
</li>
<li id="iti-2__item-si" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="386" data-country-code="si" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__si"></div>
</div><span class="iti__country-name">Slovenia</span><span class="iti__dial-code">+386</span>
</li>
<li id="iti-2__item-sb" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="677" data-country-code="sb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sb"></div>
</div><span class="iti__country-name">Solomon Islands</span><span class="iti__dial-code">+677</span>
</li>
<li id="iti-2__item-so" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="252" data-country-code="so" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__so"></div>
</div><span class="iti__country-name">Somalia</span><span class="iti__dial-code">+252</span>
</li>
<li id="iti-2__item-za" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="27" data-country-code="za" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__za"></div>
</div><span class="iti__country-name">South Africa</span><span class="iti__dial-code">+27</span>
</li>
<li id="iti-2__item-kr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="82" data-country-code="kr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kr"></div>
</div><span class="iti__country-name">South Korea</span><span class="iti__dial-code">+82</span>
</li>
<li id="iti-2__item-ss" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="211" data-country-code="ss" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ss"></div>
</div><span class="iti__country-name">South Sudan</span><span class="iti__dial-code">+211</span>
</li>
<li id="iti-2__item-es" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="34" data-country-code="es" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__es"></div>
</div><span class="iti__country-name">Spain</span><span class="iti__dial-code">+34</span>
</li>
<li id="iti-2__item-lk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="94" data-country-code="lk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lk"></div>
</div><span class="iti__country-name">Sri Lanka</span><span class="iti__dial-code">+94</span>
</li>
<li id="iti-2__item-bl" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="590" data-country-code="bl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__bl"></div>
</div><span class="iti__country-name">St. Barthélemy</span><span class="iti__dial-code">+590</span>
</li>
<li id="iti-2__item-sh" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="290" data-country-code="sh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sh"></div>
</div><span class="iti__country-name">St. Helena</span><span class="iti__dial-code">+290</span>
</li>
<li id="iti-2__item-kn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="kn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__kn"></div>
</div><span class="iti__country-name">St. Kitts & Nevis</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-lc" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="lc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__lc"></div>
</div><span class="iti__country-name">St. Lucia</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-mf" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="590" data-country-code="mf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__mf"></div>
</div><span class="iti__country-name">St. Martin</span><span class="iti__dial-code">+590</span>
</li>
<li id="iti-2__item-pm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="508" data-country-code="pm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__pm"></div>
</div><span class="iti__country-name">St. Pierre & Miquelon</span><span class="iti__dial-code">+508</span>
</li>
<li id="iti-2__item-vc" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="vc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vc"></div>
</div><span class="iti__country-name">St. Vincent & Grenadines</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-sd" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="249" data-country-code="sd" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sd"></div>
</div><span class="iti__country-name">Sudan</span><span class="iti__dial-code">+249</span>
</li>
<li id="iti-2__item-sr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="597" data-country-code="sr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sr"></div>
</div><span class="iti__country-name">Suriname</span><span class="iti__dial-code">+597</span>
</li>
<li id="iti-2__item-sj" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="47" data-country-code="sj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sj"></div>
</div><span class="iti__country-name">Svalbard & Jan Mayen</span><span class="iti__dial-code">+47</span>
</li>
<li id="iti-2__item-se" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="46" data-country-code="se" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__se"></div>
</div><span class="iti__country-name">Sweden</span><span class="iti__dial-code">+46</span>
</li>
<li id="iti-2__item-ch" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="41" data-country-code="ch" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ch"></div>
</div><span class="iti__country-name">Switzerland</span><span class="iti__dial-code">+41</span>
</li>
<li id="iti-2__item-sy" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="963" data-country-code="sy" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__sy"></div>
</div><span class="iti__country-name">Syria</span><span class="iti__dial-code">+963</span>
</li>
<li id="iti-2__item-st" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="239" data-country-code="st" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__st"></div>
</div><span class="iti__country-name">São Tomé & Príncipe</span><span class="iti__dial-code">+239</span>
</li>
<li id="iti-2__item-tw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="886" data-country-code="tw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tw"></div>
</div><span class="iti__country-name">Taiwan</span><span class="iti__dial-code">+886</span>
</li>
<li id="iti-2__item-tj" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="992" data-country-code="tj" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tj"></div>
</div><span class="iti__country-name">Tajikistan</span><span class="iti__dial-code">+992</span>
</li>
<li id="iti-2__item-tz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="255" data-country-code="tz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tz"></div>
</div><span class="iti__country-name">Tanzania</span><span class="iti__dial-code">+255</span>
</li>
<li id="iti-2__item-th" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="66" data-country-code="th" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__th"></div>
</div><span class="iti__country-name">Thailand</span><span class="iti__dial-code">+66</span>
</li>
<li id="iti-2__item-tl" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="670" data-country-code="tl" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tl"></div>
</div><span class="iti__country-name">Timor-Leste</span><span class="iti__dial-code">+670</span>
</li>
<li id="iti-2__item-tg" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="228" data-country-code="tg" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tg"></div>
</div><span class="iti__country-name">Togo</span><span class="iti__dial-code">+228</span>
</li>
<li id="iti-2__item-tk" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="690" data-country-code="tk" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tk"></div>
</div><span class="iti__country-name">Tokelau</span><span class="iti__dial-code">+690</span>
</li>
<li id="iti-2__item-to" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="676" data-country-code="to" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__to"></div>
</div><span class="iti__country-name">Tonga</span><span class="iti__dial-code">+676</span>
</li>
<li id="iti-2__item-tt" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="tt" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tt"></div>
</div><span class="iti__country-name">Trinidad & Tobago</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-tn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="216" data-country-code="tn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tn"></div>
</div><span class="iti__country-name">Tunisia</span><span class="iti__dial-code">+216</span>
</li>
<li id="iti-2__item-tr" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="90" data-country-code="tr" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tr"></div>
</div><span class="iti__country-name">Turkey</span><span class="iti__dial-code">+90</span>
</li>
<li id="iti-2__item-tm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="993" data-country-code="tm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tm"></div>
</div><span class="iti__country-name">Turkmenistan</span><span class="iti__dial-code">+993</span>
</li>
<li id="iti-2__item-tc" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="tc" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tc"></div>
</div><span class="iti__country-name">Turks & Caicos Islands</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-tv" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="688" data-country-code="tv" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__tv"></div>
</div><span class="iti__country-name">Tuvalu</span><span class="iti__dial-code">+688</span>
</li>
<li id="iti-2__item-vi" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="vi" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vi"></div>
</div><span class="iti__country-name">U.S. Virgin Islands</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-ug" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="256" data-country-code="ug" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ug"></div>
</div><span class="iti__country-name">Uganda</span><span class="iti__dial-code">+256</span>
</li>
<li id="iti-2__item-ua" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="380" data-country-code="ua" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ua"></div>
</div><span class="iti__country-name">Ukraine</span><span class="iti__dial-code">+380</span>
</li>
<li id="iti-2__item-ae" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="971" data-country-code="ae" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ae"></div>
</div><span class="iti__country-name">United Arab Emirates</span><span class="iti__dial-code">+971</span>
</li>
<li id="iti-2__item-gb" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="44" data-country-code="gb" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__gb"></div>
</div><span class="iti__country-name">United Kingdom</span><span class="iti__dial-code">+44</span>
</li>
<li id="iti-2__item-us" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="1" data-country-code="us" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__us"></div>
</div><span class="iti__country-name">United States</span><span class="iti__dial-code">+1</span>
</li>
<li id="iti-2__item-uy" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="598" data-country-code="uy" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__uy"></div>
</div><span class="iti__country-name">Uruguay</span><span class="iti__dial-code">+598</span>
</li>
<li id="iti-2__item-uz" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="998" data-country-code="uz" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__uz"></div>
</div><span class="iti__country-name">Uzbekistan</span><span class="iti__dial-code">+998</span>
</li>
<li id="iti-2__item-vu" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="678" data-country-code="vu" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vu"></div>
</div><span class="iti__country-name">Vanuatu</span><span class="iti__dial-code">+678</span>
</li>
<li id="iti-2__item-va" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="39" data-country-code="va" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__va"></div>
</div><span class="iti__country-name">Vatican City</span><span class="iti__dial-code">+39</span>
</li>
<li id="iti-2__item-ve" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="58" data-country-code="ve" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ve"></div>
</div><span class="iti__country-name">Venezuela</span><span class="iti__dial-code">+58</span>
</li>
<li id="iti-2__item-vn" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="84" data-country-code="vn" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__vn"></div>
</div><span class="iti__country-name">Vietnam</span><span class="iti__dial-code">+84</span>
</li>
<li id="iti-2__item-wf" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="681" data-country-code="wf" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__wf"></div>
</div><span class="iti__country-name">Wallis & Futuna</span><span class="iti__dial-code">+681</span>
</li>
<li id="iti-2__item-eh" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="212" data-country-code="eh" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__eh"></div>
</div><span class="iti__country-name">Western Sahara</span><span class="iti__dial-code">+212</span>
</li>
<li id="iti-2__item-ye" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="967" data-country-code="ye" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ye"></div>
</div><span class="iti__country-name">Yemen</span><span class="iti__dial-code">+967</span>
</li>
<li id="iti-2__item-zm" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="260" data-country-code="zm" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__zm"></div>
</div><span class="iti__country-name">Zambia</span><span class="iti__dial-code">+260</span>
</li>
<li id="iti-2__item-zw" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="263" data-country-code="zw" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__zw"></div>
</div><span class="iti__country-name">Zimbabwe</span><span class="iti__dial-code">+263</span>
</li>
<li id="iti-2__item-ax" class="iti__country iti__standard" tabindex="-1" role="option" data-dial-code="358" data-country-code="ax" aria-selected="false">
<div class="iti__flag-box">
<div class="iti__flag iti__ax"></div>
</div><span class="iti__country-name">Åland Islands</span><span class="iti__dial-code">+358</span>
</li>
</ul>
</div>
</div><input type="tel" id="wpforms-28835-field_5" class="wpforms-field-medium wpforms-field-required wpforms-smart-phone-field iti__tel-input wpforms-input-temp-name" data-rule-smart-phone-field="true" name="wpf-temp-wpforms[fields][5]"
aria-label="Bitte geben Sie Ihre Telefonnummer an" aria-errormessage="wpforms-28835-field_5-error" aria-describedby="wpforms-28835-field_5-description" required="" autocomplete="off" data-intl-tel-input-id="2"
placeholder="(201) 555-0123"><input type="hidden" name="wpforms[fields][5]">
</div>
<div id="wpforms-28835-field_5-description" class="wpforms-field-description">Diese Nummer wird als Kontaktnummer verwendet.</div>
</div>
<div id="wpforms-28835-field_6-container" class="wpforms-field wpforms-field-text" data-field-id="6"><label class="wpforms-field-label" for="wpforms-28835-field_6">Was ist Ihre berufliche Tätigkeit? <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="text" id="wpforms-28835-field_6" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][6]" aria-errormessage="wpforms-28835-field_6-error" required=""></div>
<div id="wpforms-28835-field_77-container" class="wpforms-field wpforms-field-gdpr-checkbox" data-field-id="77"><label class="wpforms-field-label">revDSG Einverständnis <span class="wpforms-required-label" aria-hidden="true">*</span></label>
<ul id="wpforms-28835-field_77" class="wpforms-field-required">
<li class="choice-1"><input type="checkbox" id="wpforms-28835-field_77_1" name="wpforms[fields][77][]" value="Ich willige ein, dass diese Website meine übermittelten Informationen speichert, sodass meine Anfrage beantwortet werden kann."
aria-errormessage="wpforms-28835-field_77_1-error" required=""><label class="wpforms-field-label-inline" for="wpforms-28835-field_77_1">Ich willige ein, dass diese Website meine übermittelten Informationen speichert, sodass meine
Anfrage beantwortet werden kann.</label></li>
</ul>
</div>
<div id="wpforms-28835-field_9-container" class="wpforms-field wpforms-field-divider" data-field-id="9">
<h3 id="wpforms-28835-field_9" aria-errormessage="wpforms-28835-field_9-error">Ihre Motivation</h3>
</div>
<div id="wpforms-28835-field_3-container" class="wpforms-field wpforms-field-text" data-field-type="text" data-field-id="3"
style="position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important;">
<label class="wpforms-field-label" for="wpforms-28835-field_3" aria-hidden="true">ein cm) im</label>
<input type="text" id="wpforms-28835-field_3" class="wpforms-field-medium" name="wpforms[fields][3]" aria-hidden="true" style="visibility: hidden;" tabindex="-1">
</div>
<div id="wpforms-28835-field_10-container" class="wpforms-field wpforms-field-textarea" data-field-id="10"><label class="wpforms-field-label" for="wpforms-28835-field_10">Beschreiben Sie den Hauptgrund, weshalb Sie sich für ein persönliches
Gesundheitscoaching entschieden haben. <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-28835-field_10" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][10]"
aria-errormessage="wpforms-28835-field_10-error" required=""></textarea></div>
<div id="wpforms-28835-field_20-container" class="wpforms-field wpforms-field-checkbox wpforms-conditional-trigger" data-field-id="20">
<fieldset>
<legend class="wpforms-field-label">Was sind Ihre Ziele für das Gesundheitscoaching? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_20" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="checkbox" id="wpforms-28835-field_20_1" name="wpforms[fields][20][]" value="Mental besser fühlen" aria-errormessage="wpforms-28835-field_20_1-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_20_1">Mental besser fühlen</label></li>
<li class="choice-2 depth-1"><input type="checkbox" id="wpforms-28835-field_20_2" name="wpforms[fields][20][]" value="Stress regulieren" aria-errormessage="wpforms-28835-field_20_2-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_20_2">Stress regulieren</label></li>
<li class="choice-3 depth-1"><input type="checkbox" id="wpforms-28835-field_20_3" name="wpforms[fields][20][]" value="Besser schlafen" aria-errormessage="wpforms-28835-field_20_3-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_20_3">Besser schlafen</label></li>
<li class="choice-4 depth-1"><input type="checkbox" id="wpforms-28835-field_20_4" name="wpforms[fields][20][]" value="Körperliche Beschwerden reduzieren" aria-errormessage="wpforms-28835-field_20_4-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_20_4">Körperliche Beschwerden reduzieren</label></li>
<li class="choice-5 depth-1"><input type="checkbox" id="wpforms-28835-field_20_5" name="wpforms[fields][20][]" value="Körperlich aktiver sein" aria-errormessage="wpforms-28835-field_20_5-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_20_5">Körperlich aktiver sein</label></li>
<li class="choice-6 depth-1"><input type="checkbox" id="wpforms-28835-field_20_6" name="wpforms[fields][20][]" value="Gesünder ernähren" aria-errormessage="wpforms-28835-field_20_6-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_20_6">Gesünder ernähren</label></li>
<li class="choice-7 depth-1"><input type="checkbox" id="wpforms-28835-field_20_7" name="wpforms[fields][20][]" value="Sonstiges" aria-errormessage="wpforms-28835-field_20_7-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_20_7">Sonstiges</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_12-container" class="wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-hide" data-field-id="12" style="display:none;"><label class="wpforms-field-label"
for="wpforms-28835-field_12">Falls Sie körperliche Beschwerden reduzieren möchten: um welche handelt es sich? <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-28835-field_12"
class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][12]" aria-errormessage="wpforms-28835-field_12-error" required=""></textarea></div>
<div id="wpforms-28835-field_38-container" class="wpforms-field wpforms-field-pagebreak" data-field-id="38">
<div class="wpforms-clear wpforms-pagebreak-left"><button class="wpforms-page-button wpforms-page-next" data-action="next" data-page="1" data-formid="28835" aria-disabled="false"
aria-describedby="">Weiter</button><a href="#" class="wpforms-save-resume-button"><span>Speichern und später fortsetzen</span></a></div>
</div>
</div>
<div class="wpforms-page wpforms-page-2 " data-page="2" style="display:none;">
<div id="wpforms-28835-field_16-container" class="wpforms-field wpforms-field-divider" data-field-id="16">
<h3 id="wpforms-28835-field_16" aria-errormessage="wpforms-28835-field_16-error">Anamnese</h3>
</div>
<div id="wpforms-28835-field_17-container" class="wpforms-field wpforms-field-number" data-field-id="17"><label class="wpforms-field-label" for="wpforms-28835-field_17">Ihre Grösse (in cm) <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="number" id="wpforms-28835-field_17" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][17]" aria-errormessage="wpforms-28835-field_17-error" required=""></div>
<div id="wpforms-28835-field_18-container" class="wpforms-field wpforms-field-number" data-field-id="18"><label class="wpforms-field-label" for="wpforms-28835-field_18">Ihr Gewicht (in kg) <span class="wpforms-required-label"
aria-hidden="true">*</span></label><input type="number" id="wpforms-28835-field_18" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][18]" aria-errormessage="wpforms-28835-field_18-error" required=""></div>
<div id="wpforms-28835-field_21-container" class="wpforms-field wpforms-field-radio" data-field-id="21">
<fieldset>
<legend class="wpforms-field-label">Wurden bei Ihnen Krankheiten diagnostiziert? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_21" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_21_1" name="wpforms[fields][21]" value="Ja" aria-errormessage="wpforms-28835-field_21_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_21_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_21_2" name="wpforms[fields][21]" value="Nein" aria-errormessage="wpforms-28835-field_21_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_21_2">Nein</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_21_3" name="wpforms[fields][21]" value="Die Hausarztpraxis Huttwil verfügt über alle Informationen zu meinen Krankheiten."
aria-errormessage="wpforms-28835-field_21_3-error" required=""><label class="wpforms-field-label-inline" for="wpforms-28835-field_21_3">Die Hausarztpraxis Huttwil verfügt über alle Informationen zu meinen Krankheiten.</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_22-container" class="wpforms-field wpforms-field-radio wpforms-conditional-trigger" data-field-id="22">
<fieldset>
<legend class="wpforms-field-label">Befinden Sie sich derzeit in ärztlicher oder therapeutischer Behandlung? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_22" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_22_1" name="wpforms[fields][22]" value="Ja" aria-errormessage="wpforms-28835-field_22_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_22_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_22_2" name="wpforms[fields][22]" value="Nein" aria-errormessage="wpforms-28835-field_22_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_22_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_23-container" class="wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-hide" data-field-id="23" style="display:none;"><label class="wpforms-field-label"
for="wpforms-28835-field_23">Bei welchen Gesundheitsfachpersonen befinden Sie sich in ärztlicher oder therapeutischer Behandlung? (Hausarztpraxis / Physiotherapie / Ernährungsberatung / Naturheilpraktik / Neuraltherapie / Psychotherapie
u.s.w.) <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-28835-field_23" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][23]"
aria-errormessage="wpforms-28835-field_23-error" required=""></textarea></div>
<div id="wpforms-28835-field_24-container" class="wpforms-field wpforms-field-radio wpforms-conditional-trigger" data-field-id="24">
<fieldset>
<legend class="wpforms-field-label">Hatten Sie kürzlich eine Operation? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_24" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_24_1" name="wpforms[fields][24]" value="Ja" aria-errormessage="wpforms-28835-field_24_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_24_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_24_2" name="wpforms[fields][24]" value="Nein" aria-errormessage="wpforms-28835-field_24_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_24_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_25-container" class="wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-hide" data-field-id="25" style="display:none;"><label class="wpforms-field-label"
for="wpforms-28835-field_25">Was für eine Operation hatten Sie kürzlich? <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-28835-field_25" class="wpforms-field-medium wpforms-field-required"
name="wpforms[fields][25]" aria-errormessage="wpforms-28835-field_25-error" required=""></textarea></div>
<div id="wpforms-28835-field_26-container" class="wpforms-field wpforms-field-radio wpforms-conditional-trigger" data-field-id="26">
<fieldset>
<legend class="wpforms-field-label">Leiden Sie unter Allergien? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_26" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_26_1" name="wpforms[fields][26]" value="Ja" aria-errormessage="wpforms-28835-field_26_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_26_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_26_2" name="wpforms[fields][26]" value="Nein" aria-errormessage="wpforms-28835-field_26_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_26_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_27-container" class="wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-hide" data-field-id="27" style="display:none;"><label class="wpforms-field-label"
for="wpforms-28835-field_27">Welche Allergien haben Sie? <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-28835-field_27" class="wpforms-field-medium wpforms-field-required"
name="wpforms[fields][27]" aria-errormessage="wpforms-28835-field_27-error" required=""></textarea></div>
<div id="wpforms-28835-field_28-container" class="wpforms-field wpforms-field-radio wpforms-conditional-trigger" data-field-id="28">
<fieldset>
<legend class="wpforms-field-label">Rauchen Sie? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_28" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_28_1" name="wpforms[fields][28]" value="Ja" aria-errormessage="wpforms-28835-field_28_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_28_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_28_2" name="wpforms[fields][28]" value="Nein" aria-errormessage="wpforms-28835-field_28_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_28_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_29-container" class="wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-hide" data-field-id="29" style="display:none;"><label class="wpforms-field-label"
for="wpforms-28835-field_29">Wie viele Zigaretten rauchen Sie pro Tag? <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-28835-field_29" class="wpforms-field-medium wpforms-field-required"
name="wpforms[fields][29]" aria-errormessage="wpforms-28835-field_29-error" required=""></textarea></div>
<div id="wpforms-28835-field_30-container" class="wpforms-field wpforms-field-radio" data-field-id="30">
<fieldset>
<legend class="wpforms-field-label">Sind Sie schwanger oder haben Sie in den letzten 6 Monaten geboren? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_30" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_30_1" name="wpforms[fields][30]" value="Ja" aria-errormessage="wpforms-28835-field_30_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_30_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_30_2" name="wpforms[fields][30]" value="Nein" aria-errormessage="wpforms-28835-field_30_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_30_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_31-container" class="wpforms-field wpforms-field-radio" data-field-id="31">
<fieldset>
<legend class="wpforms-field-label">Hat Ihnen ein Arzt jemals gesagt, dass Sie ein Herzleiden ODER einen hohen Blutdruck haben? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_31" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_31_1" name="wpforms[fields][31]" value="Ja" aria-errormessage="wpforms-28835-field_31_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_31_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_31_2" name="wpforms[fields][31]" value="Nein" aria-errormessage="wpforms-28835-field_31_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_31_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_32-container" class="wpforms-field wpforms-field-radio" data-field-id="32">
<fieldset>
<legend class="wpforms-field-label">Verlieren Sie Ihr Gleichgewicht aufgrund von Schwindelgefühlen ODER haben Sie in den letzten 12 Monaten das Bewusstsein verloren? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_32" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_32_1" name="wpforms[fields][32]" value="Ja" aria-errormessage="wpforms-28835-field_32_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_32_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_32_2" name="wpforms[fields][32]" value="Nein" aria-errormessage="wpforms-28835-field_32_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_32_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_33-container" class="wpforms-field wpforms-field-radio wpforms-conditional-trigger" data-field-id="33">
<fieldset>
<legend class="wpforms-field-label">Nehmen Sie derzeit Medikamente ein (auch nicht-rezeptpflichtige)? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_33" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_33_1" name="wpforms[fields][33]" value="Ja" aria-errormessage="wpforms-28835-field_33_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_33_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_33_2" name="wpforms[fields][33]" value="Nein" aria-errormessage="wpforms-28835-field_33_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_33_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_34-container" class="wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-hide" data-field-id="34" style="display:none;"><label class="wpforms-field-label"
for="wpforms-28835-field_34">Welche Medikamente oder Produkte nehmen Sie ein? <span class="wpforms-required-label" aria-hidden="true">*</span></label><textarea id="wpforms-28835-field_34" class="wpforms-field-medium wpforms-field-required"
name="wpforms[fields][34]" aria-errormessage="wpforms-28835-field_34-error" required=""></textarea></div>
<div id="wpforms-28835-field_35-container" class="wpforms-field wpforms-field-likert_scale" data-field-id="35">
<fieldset>
<legend class="wpforms-field-label">Wie würden Sie Ihr aktuelles Fitnesslevel bezeichnen von 1-10? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<table cellspacing="0" cellpadding="0" class="wpforms-field-large modern single-row">
<thead>
<tr>
<th style="width:10%;">1</th>
<th style="width:10%;">2</th>
<th style="width:10%;">3</th>
<th style="width:10%;">4</th>
<th style="width:10%;">5</th>
<th style="width:10%;">6</th>
<th style="width:10%;">7</th>
<th style="width:10%;">8</th>
<th style="width:10%;">9</th>
<th style="width:10%;">10</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_35_1_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="1" aria-errormessage="wpforms-28835-field_35_1_1-error" required=""><label
for="wpforms-28835-field_35_1_1"><span class="wpforms-screen-reader-element">Fitnesslevel 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_35_1_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="2" aria-errormessage="wpforms-28835-field_35_1_2-error" required=""><label
for="wpforms-28835-field_35_1_2"><span class="wpforms-screen-reader-element">Fitnesslevel 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_35_1_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="3" aria-errormessage="wpforms-28835-field_35_1_3-error" required=""><label
for="wpforms-28835-field_35_1_3"><span class="wpforms-screen-reader-element">Fitnesslevel 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_35_1_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="4" aria-errormessage="wpforms-28835-field_35_1_4-error" required=""><label
for="wpforms-28835-field_35_1_4"><span class="wpforms-screen-reader-element">Fitnesslevel 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_35_1_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="5" aria-errormessage="wpforms-28835-field_35_1_5-error" required=""><label
for="wpforms-28835-field_35_1_5"><span class="wpforms-screen-reader-element">Fitnesslevel 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_35_1_6"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="6" aria-errormessage="wpforms-28835-field_35_1_6-error" required=""><label
for="wpforms-28835-field_35_1_6"><span class="wpforms-screen-reader-element">Fitnesslevel 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_35_1_7"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="7" aria-errormessage="wpforms-28835-field_35_1_7-error" required=""><label
for="wpforms-28835-field_35_1_7"><span class="wpforms-screen-reader-element">Fitnesslevel 7</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">8</span><input type="radio" id="wpforms-28835-field_35_1_8"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="8" aria-errormessage="wpforms-28835-field_35_1_8-error" required=""><label
for="wpforms-28835-field_35_1_8"><span class="wpforms-screen-reader-element">Fitnesslevel 8</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">9</span><input type="radio" id="wpforms-28835-field_35_1_9"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="9" aria-errormessage="wpforms-28835-field_35_1_9-error" required=""><label
for="wpforms-28835-field_35_1_9"><span class="wpforms-screen-reader-element">Fitnesslevel 9</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">10</span><input type="radio" id="wpforms-28835-field_35_1_10"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][35][1]" value="10" aria-errormessage="wpforms-28835-field_35_1_10-error" required=""><label
for="wpforms-28835-field_35_1_10"><span class="wpforms-screen-reader-element">Fitnesslevel 10</span></label></div>
</td>
</tr>
</tbody>
</table>
</fieldset>
</div>
<div id="wpforms-28835-field_36-container" class="wpforms-field wpforms-field-pagebreak" data-field-id="36">
<div class="wpforms-clear wpforms-pagebreak-left"><button class="wpforms-page-button wpforms-page-prev" data-action="prev" data-page="2" data-formid="28835" aria-disabled="false" aria-describedby="">Zurück</button><button
class="wpforms-page-button wpforms-page-next" data-action="next" data-page="2" data-formid="28835" aria-disabled="false"
aria-describedby="">Weiter</button><a href="#" class="wpforms-save-resume-button"><span>Speichern und später fortsetzen</span></a></div>
</div>
</div>
<div class="wpforms-page wpforms-page-3 " data-page="3" style="display:none;">
<div id="wpforms-28835-field_37-container" class="wpforms-field wpforms-field-divider" data-field-id="37">
<h3 id="wpforms-28835-field_37" aria-errormessage="wpforms-28835-field_37-error">Lebensstil</h3>
</div>
<div id="wpforms-28835-field_39-container" class="wpforms-field wpforms-field-number" data-field-id="39"><label class="wpforms-field-label" for="wpforms-28835-field_39">Wieviel Stunden sitzen oder liegen Sie täglich (ohne Schlafenszeit)? <span
class="wpforms-required-label" aria-hidden="true">*</span></label><input type="number" id="wpforms-28835-field_39" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][39]"
aria-errormessage="wpforms-28835-field_39-error" aria-describedby="wpforms-28835-field_39-description" required="">
<div id="wpforms-28835-field_39-description" class="wpforms-field-description">Während der Arbeit, beim Essen, auf dem Sofa liegend etc. </div>
</div>
<div id="wpforms-28835-field_40-container" class="wpforms-field wpforms-field-number" data-field-id="40"><label class="wpforms-field-label" for="wpforms-28835-field_40">Für wie viele Minuten pro Woche bewegen Sie sich mit mittlerer Intensität?
<span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="number" id="wpforms-28835-field_40" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][40]"
aria-errormessage="wpforms-28835-field_40-error" aria-describedby="wpforms-28835-field_40-description" required="">
<div id="wpforms-28835-field_40-description" class="wpforms-field-description">(Mittlere Intensität = Sie beginnen verstärkt zu atmen und Ihr Puls ist erhöht. Sie könnten bei der Aktivität noch sprechen. -> Zum Beispiel zügiges zu Fuss
gehen, Velofahren, Gartenarbeiten)</div>
</div>
<div id="wpforms-28835-field_41-container" class="wpforms-field wpforms-field-number" data-field-id="41"><label class="wpforms-field-label" for="wpforms-28835-field_41">Für wie viele Minuten pro Woche bewegen Sie sich mit hoher
Intensität?</label><input type="number" id="wpforms-28835-field_41" class="wpforms-field-medium" name="wpforms[fields][41]" aria-errormessage="wpforms-28835-field_41-error" aria-describedby="wpforms-28835-field_41-description">
<div id="wpforms-28835-field_41-description" class="wpforms-field-description">(Hohe Intensität = Ihr Puls ist stark erhöht, Sie atmen mit hoher Frequenz. Während der Aktivität sind nur noch kurze Wortwechsel möglich. -> Zum Beispiel
Jogging, Krafttraining an Fitnessgeräten, Liegestützen)</div>
</div>
<div id="wpforms-28835-field_42-container" class="wpforms-field wpforms-field-radio wpforms-conditional-trigger" data-field-id="42">
<fieldset>
<legend class="wpforms-field-label">Treiben Sie Sport? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_42" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_42_1" name="wpforms[fields][42]" value="Ja" aria-errormessage="wpforms-28835-field_42_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_42_1">Ja</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_42_2" name="wpforms[fields][42]" value="Nein" aria-errormessage="wpforms-28835-field_42_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_42_2">Nein</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_43-container" class="wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-hide" data-field-id="43" style="display:none;"><label class="wpforms-field-label"
for="wpforms-28835-field_43">Welchen Sport betreiben Sie? <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="text" id="wpforms-28835-field_43" class="wpforms-field-medium wpforms-field-required"
name="wpforms[fields][43]" aria-errormessage="wpforms-28835-field_43-error" required=""></div>
<div id="wpforms-28835-field_44-container" class="wpforms-field wpforms-field-radio" data-field-id="44">
<fieldset>
<legend class="wpforms-field-label">Wie oft betreiben Sie Krafttraining, welches alle grossen Muskelgruppen (Beine, Hüfte, Rücken, Bauch, Brust, Schultern und Arme) trainiert? <span class="wpforms-required-label" aria-hidden="true">*</span>
</legend>
<ul id="wpforms-28835-field_44" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_44_1" name="wpforms[fields][44]" value="Nie" aria-errormessage="wpforms-28835-field_44_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_44_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_44_2" name="wpforms[fields][44]" value="Ca. 1-mal im Monat" aria-errormessage="wpforms-28835-field_44_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_44_2">Ca. 1-mal im Monat</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_44_3" name="wpforms[fields][44]" value="Ca. 2-mal im Monat" aria-errormessage="wpforms-28835-field_44_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_44_3">Ca. 2-mal im Monat</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_44_4" name="wpforms[fields][44]" value="Ca. 1-mal pro Woche" aria-errormessage="wpforms-28835-field_44_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_44_4">Ca. 1-mal pro Woche</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_44_5" name="wpforms[fields][44]" value="Ca. 2-mal pro Woche" aria-errormessage="wpforms-28835-field_44_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_44_5">Ca. 2-mal pro Woche</label></li>
<li class="choice-6 depth-1"><input type="radio" id="wpforms-28835-field_44_6" name="wpforms[fields][44]" value="Ca. 3-mal oder mehr pro Woche" aria-errormessage="wpforms-28835-field_44_6-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_44_6">Ca. 3-mal oder mehr pro Woche</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_45-container" class="wpforms-field wpforms-field-checkbox" data-field-id="45">
<fieldset>
<legend class="wpforms-field-label">Wo sind Sie am liebsten körperlich aktiv? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_45" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="checkbox" id="wpforms-28835-field_45_1" name="wpforms[fields][45][]" value="Draussen" aria-errormessage="wpforms-28835-field_45_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_45_1">Draussen</label></li>
<li class="choice-2 depth-1"><input type="checkbox" id="wpforms-28835-field_45_2" name="wpforms[fields][45][]" value="Drinnen" aria-errormessage="wpforms-28835-field_45_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_45_2">Drinnen</label></li>
<li class="choice-3 depth-1"><input type="checkbox" id="wpforms-28835-field_45_3" name="wpforms[fields][45][]" value="Beides" aria-errormessage="wpforms-28835-field_45_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_45_3">Beides</label></li>
<li class="choice-4 depth-1"><input type="checkbox" id="wpforms-28835-field_45_4" name="wpforms[fields][45][]" value="Spielt mir keine Rolle" aria-errormessage="wpforms-28835-field_45_4-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_45_4">Spielt mir keine Rolle</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_46-container" class="wpforms-field wpforms-field-checkbox" data-field-id="46">
<fieldset>
<legend class="wpforms-field-label">In welcher sozialen Form betätigen Sie sich körperlich am liebsten? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_46" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="checkbox" id="wpforms-28835-field_46_1" name="wpforms[fields][46][]" value="Alleine" aria-errormessage="wpforms-28835-field_46_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_46_1">Alleine</label></li>
<li class="choice-2 depth-1"><input type="checkbox" id="wpforms-28835-field_46_2" name="wpforms[fields][46][]" value="In der Gruppe" aria-errormessage="wpforms-28835-field_46_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_46_2">In der Gruppe</label></li>
<li class="choice-3 depth-1"><input type="checkbox" id="wpforms-28835-field_46_3" name="wpforms[fields][46][]" value="Mit einer nahestehenden Person" aria-errormessage="wpforms-28835-field_46_3-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_46_3">Mit einer nahestehenden Person</label></li>
<li class="choice-4 depth-1"><input type="checkbox" id="wpforms-28835-field_46_4" name="wpforms[fields][46][]" value="Weiss nicht" aria-errormessage="wpforms-28835-field_46_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_46_4">Weiss nicht</label></li>
<li class="choice-5 depth-1"><input type="checkbox" id="wpforms-28835-field_46_5" name="wpforms[fields][46][]" value="Spielt mir keine Rolle" aria-errormessage="wpforms-28835-field_46_5-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_46_5">Spielt mir keine Rolle</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_47-container" class="wpforms-field wpforms-field-textarea" data-field-id="47"><label class="wpforms-field-label" for="wpforms-28835-field_47">Falls Sie gerne aktiver wären. Was sind die Gründe, wieso Sie eventuell
noch nicht so weit sind?</label><textarea id="wpforms-28835-field_47" class="wpforms-field-medium" name="wpforms[fields][47]" aria-errormessage="wpforms-28835-field_47-error"></textarea></div>
<div id="wpforms-28835-field_48-container" class="wpforms-field wpforms-field-radio" data-field-id="48">
<fieldset>
<legend class="wpforms-field-label">Wie oft essen Sie im Alltag auswärts z.B. im Restaurant oder der Kantine? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_48" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_48_1" name="wpforms[fields][48]" value="Täglich" aria-errormessage="wpforms-28835-field_48_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_48_1">Täglich</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_48_2" name="wpforms[fields][48]" value="Mehrmals pro Woche" aria-errormessage="wpforms-28835-field_48_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_48_2">Mehrmals pro Woche</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_48_3" name="wpforms[fields][48]" value="Ca. 1-mal pro Woche" aria-errormessage="wpforms-28835-field_48_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_48_3">Ca. 1-mal pro Woche</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_48_4" name="wpforms[fields][48]" value="Ca. 2-3 mal pro Monat" aria-errormessage="wpforms-28835-field_48_4-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_48_4">Ca. 2-3 mal pro Monat</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_48_5" name="wpforms[fields][48]" value="Sehr selten" aria-errormessage="wpforms-28835-field_48_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_48_5">Sehr selten</label></li>
<li class="choice-6 depth-1"><input type="radio" id="wpforms-28835-field_48_6" name="wpforms[fields][48]" value="Nie" aria-errormessage="wpforms-28835-field_48_6-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_48_6">Nie</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_49-container" class="wpforms-field wpforms-field-checkbox" data-field-id="49">
<fieldset>
<legend class="wpforms-field-label">Wie essen Sie normalerweise zuhause? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_49" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="checkbox" id="wpforms-28835-field_49_1" name="wpforms[fields][49][]" value="Mit einer oder mehreren anderen erwachsenen Personen" aria-errormessage="wpforms-28835-field_49_1-error"
required=""><label class="wpforms-field-label-inline" for="wpforms-28835-field_49_1">Mit einer oder mehreren anderen erwachsenen Personen</label></li>
<li class="choice-2 depth-1"><input type="checkbox" id="wpforms-28835-field_49_2" name="wpforms[fields][49][]" value="Mit einem oder mehreren Kindern" aria-errormessage="wpforms-28835-field_49_2-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_49_2">Mit einem oder mehreren Kindern</label></li>
<li class="choice-3 depth-1"><input type="checkbox" id="wpforms-28835-field_49_3" name="wpforms[fields][49][]" value="Alleine" aria-errormessage="wpforms-28835-field_49_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_49_3">Alleine</label></li>
<li class="choice-4 depth-1"><input type="checkbox" id="wpforms-28835-field_49_4" name="wpforms[fields][49][]" value="Sonstiges" aria-errormessage="wpforms-28835-field_49_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_49_4">Sonstiges</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_50-container" class="wpforms-field wpforms-field-radio" data-field-id="50">
<fieldset>
<legend class="wpforms-field-label">Wer kocht bei Ihnen zuhause? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_50" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_50_1" name="wpforms[fields][50]" value="Ich" aria-errormessage="wpforms-28835-field_50_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_50_1">Ich</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_50_2" name="wpforms[fields][50]" value="Ich, gemeinsam oder abwechselnd mit anderen Personen" aria-errormessage="wpforms-28835-field_50_2-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_50_2">Ich, gemeinsam oder abwechselnd mit anderen Personen</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_50_3" name="wpforms[fields][50]" value="Jemand anderes" aria-errormessage="wpforms-28835-field_50_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_50_3">Jemand anderes</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_50_4" name="wpforms[fields][50]" value="Sonstiges" aria-errormessage="wpforms-28835-field_50_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_50_4">Sonstiges</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_57-container" class="wpforms-field wpforms-field-likert_scale" data-field-id="57">
<fieldset>
<legend class="wpforms-field-label">Wie oft essen Sie folgende Produkte <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<table cellspacing="0" cellpadding="0" class="wpforms-field-large modern">
<thead>
<tr>
<th style="width:20%;"></th>
<th style="width:13%;">Nie</th>
<th style="width:13%;">Seltener als 1-mal pro Woche</th>
<th style="width:13%;">Ca. 1-mal pro Woche</th>
<th style="width:13%;">Mehrmals pro Woche</th>
<th style="width:13%;">Täglich</th>
<th style="width:13%;">Mehrmals täglich</th>
</tr>
</thead>
<tbody>
<tr>
<th>Früchte (Fruchtsäfte zählen nicht)</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Nie</span><input type="radio" id="wpforms-28835-field_57_4_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][4]" value="1" aria-errormessage="wpforms-28835-field_57_4_1-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_4_1"><span class="wpforms-screen-reader-element">Früchte (Fruchtsäfte zählen nicht) Nie</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Seltener als 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_4_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][4]" value="2" aria-errormessage="wpforms-28835-field_57_4_2-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_4_2"><span class="wpforms-screen-reader-element">Früchte (Fruchtsäfte zählen nicht) Seltener als 1-mal pro Woche</span></label>
</div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Ca. 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_4_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][4]" value="3" aria-errormessage="wpforms-28835-field_57_4_3-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_4_3"><span class="wpforms-screen-reader-element">Früchte (Fruchtsäfte zählen nicht) Ca. 1-mal pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals pro Woche</span><input type="radio" id="wpforms-28835-field_57_4_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][4]" value="4" aria-errormessage="wpforms-28835-field_57_4_4-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_4_4"><span class="wpforms-screen-reader-element">Früchte (Fruchtsäfte zählen nicht) Mehrmals pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Täglich</span><input type="radio" id="wpforms-28835-field_57_4_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][4]" value="5" aria-errormessage="wpforms-28835-field_57_4_5-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_4_5"><span class="wpforms-screen-reader-element">Früchte (Fruchtsäfte zählen nicht) Täglich</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals täglich</span><input type="radio" id="wpforms-28835-field_57_4_6"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][4]" value="6" aria-errormessage="wpforms-28835-field_57_4_6-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_4_6"><span class="wpforms-screen-reader-element">Früchte (Fruchtsäfte zählen nicht) Mehrmals täglich</span></label></div>
</td>
</tr>
<tr>
<th>Ungesalzene Nüsse oder Samen</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Nie</span><input type="radio" id="wpforms-28835-field_57_1_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][1]" value="1" aria-errormessage="wpforms-28835-field_57_1_1-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_1_1"><span class="wpforms-screen-reader-element">Ungesalzene Nüsse oder Samen Nie</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Seltener als 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_1_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][1]" value="2" aria-errormessage="wpforms-28835-field_57_1_2-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_1_2"><span class="wpforms-screen-reader-element">Ungesalzene Nüsse oder Samen Seltener als 1-mal pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Ca. 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_1_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][1]" value="3" aria-errormessage="wpforms-28835-field_57_1_3-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_1_3"><span class="wpforms-screen-reader-element">Ungesalzene Nüsse oder Samen Ca. 1-mal pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals pro Woche</span><input type="radio" id="wpforms-28835-field_57_1_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][1]" value="4" aria-errormessage="wpforms-28835-field_57_1_4-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_1_4"><span class="wpforms-screen-reader-element">Ungesalzene Nüsse oder Samen Mehrmals pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Täglich</span><input type="radio" id="wpforms-28835-field_57_1_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][1]" value="5" aria-errormessage="wpforms-28835-field_57_1_5-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_1_5"><span class="wpforms-screen-reader-element">Ungesalzene Nüsse oder Samen Täglich</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals täglich</span><input type="radio" id="wpforms-28835-field_57_1_6"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][1]" value="6" aria-errormessage="wpforms-28835-field_57_1_6-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_1_6"><span class="wpforms-screen-reader-element">Ungesalzene Nüsse oder Samen Mehrmals täglich</span></label></div>
</td>
</tr>
<tr>
<th>Gemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?*</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Nie</span><input type="radio" id="wpforms-28835-field_57_2_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][2]" value="1" aria-errormessage="wpforms-28835-field_57_2_1-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_2_1"><span class="wpforms-screen-reader-element">Gemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Nie</span></label>
</div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Seltener als 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_2_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][2]" value="2" aria-errormessage="wpforms-28835-field_57_2_2-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_2_2"><span class="wpforms-screen-reader-element">Gemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Seltener als 1-mal
pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Ca. 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_2_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][2]" value="3" aria-errormessage="wpforms-28835-field_57_2_3-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_2_3"><span class="wpforms-screen-reader-element">Gemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Ca. 1-mal pro
Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals pro Woche</span><input type="radio" id="wpforms-28835-field_57_2_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][2]" value="4" aria-errormessage="wpforms-28835-field_57_2_4-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_2_4"><span class="wpforms-screen-reader-element">Gemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Mehrmals pro
Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Täglich</span><input type="radio" id="wpforms-28835-field_57_2_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][2]" value="5" aria-errormessage="wpforms-28835-field_57_2_5-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_2_5"><span class="wpforms-screen-reader-element">Gemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?*
Täglich</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals täglich</span><input type="radio" id="wpforms-28835-field_57_2_6"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][2]" value="6" aria-errormessage="wpforms-28835-field_57_2_6-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_2_6"><span class="wpforms-screen-reader-element">Gemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Mehrmals
täglich</span></label></div>
</td>
</tr>
<tr>
<th>Hülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.)</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Nie</span><input type="radio" id="wpforms-28835-field_57_5_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][5]" value="1" aria-errormessage="wpforms-28835-field_57_5_1-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_5_1"><span class="wpforms-screen-reader-element">Hülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Nie</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Seltener als 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_5_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][5]" value="2" aria-errormessage="wpforms-28835-field_57_5_2-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_5_2"><span class="wpforms-screen-reader-element">Hülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Seltener als 1-mal pro
Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Ca. 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_5_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][5]" value="3" aria-errormessage="wpforms-28835-field_57_5_3-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_5_3"><span class="wpforms-screen-reader-element">Hülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Ca. 1-mal pro
Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals pro Woche</span><input type="radio" id="wpforms-28835-field_57_5_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][5]" value="4" aria-errormessage="wpforms-28835-field_57_5_4-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_5_4"><span class="wpforms-screen-reader-element">Hülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Mehrmals pro
Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Täglich</span><input type="radio" id="wpforms-28835-field_57_5_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][5]" value="5" aria-errormessage="wpforms-28835-field_57_5_5-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_5_5"><span class="wpforms-screen-reader-element">Hülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Täglich</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals täglich</span><input type="radio" id="wpforms-28835-field_57_5_6"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][5]" value="6" aria-errormessage="wpforms-28835-field_57_5_6-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_5_6"><span class="wpforms-screen-reader-element">Hülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Mehrmals
täglich</span></label></div>
</td>
</tr>
<tr>
<th>Fleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.)</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Nie</span><input type="radio" id="wpforms-28835-field_57_6_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][6]" value="1" aria-errormessage="wpforms-28835-field_57_6_1-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_6_1"><span class="wpforms-screen-reader-element">Fleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.)
Nie</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Seltener als 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_6_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][6]" value="2" aria-errormessage="wpforms-28835-field_57_6_2-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_6_2"><span class="wpforms-screen-reader-element">Fleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Seltener als
1-mal pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Ca. 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_57_6_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][6]" value="3" aria-errormessage="wpforms-28835-field_57_6_3-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_6_3"><span class="wpforms-screen-reader-element">Fleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Ca. 1-mal pro
Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals pro Woche</span><input type="radio" id="wpforms-28835-field_57_6_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][6]" value="4" aria-errormessage="wpforms-28835-field_57_6_4-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_6_4"><span class="wpforms-screen-reader-element">Fleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Mehrmals pro
Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Täglich</span><input type="radio" id="wpforms-28835-field_57_6_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][6]" value="5" aria-errormessage="wpforms-28835-field_57_6_5-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_6_5"><span class="wpforms-screen-reader-element">Fleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.)
Täglich</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals täglich</span><input type="radio" id="wpforms-28835-field_57_6_6"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][57][6]" value="6" aria-errormessage="wpforms-28835-field_57_6_6-error"
aria-describedby="wpforms-28835-field_57-description" required=""><label for="wpforms-28835-field_57_6_6"><span class="wpforms-screen-reader-element">Fleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Mehrmals
täglich</span></label></div>
</td>
</tr>
</tbody>
</table>
<div id="wpforms-28835-field_57-description" class="wpforms-field-description">*Stärkehaltige Gemüse wie Kartoffeln, Mais oder Gemüsesaft zählen nicht </div>
</fieldset>
</div>
<div id="wpforms-28835-field_54-container" class="wpforms-field wpforms-field-radio" data-field-id="54">
<fieldset>
<legend class="wpforms-field-label">Wie oft essen Sie Vollkornprodukte anstelle von anderen Getreideprodukten? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_54" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_54_1" name="wpforms[fields][54]" value="Nie" aria-errormessage="wpforms-28835-field_54_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_54_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_54_2" name="wpforms[fields][54]" value="Ab und zu" aria-errormessage="wpforms-28835-field_54_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_54_2">Ab und zu</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_54_3" name="wpforms[fields][54]" value="Oft" aria-errormessage="wpforms-28835-field_54_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_54_3">Oft</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_54_4" name="wpforms[fields][54]" value="Fast immer" aria-errormessage="wpforms-28835-field_54_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_54_4">Fast immer</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_58-container" class="wpforms-field wpforms-field-radio" data-field-id="58">
<fieldset>
<legend class="wpforms-field-label">Wie oft essen Sie, um andere Bedürfnisse als Ihren Hunger zu stillen, zum Beispiel aus Langeweile, Stress oder Einsamkeit? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_58" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_58_1" name="wpforms[fields][58]" value="Nie" aria-errormessage="wpforms-28835-field_58_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_58_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_58_2" name="wpforms[fields][58]" value="Selten" aria-errormessage="wpforms-28835-field_58_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_58_2">Selten</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_58_3" name="wpforms[fields][58]" value="Manchmal" aria-errormessage="wpforms-28835-field_58_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_58_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_58_4" name="wpforms[fields][58]" value="Oft" aria-errormessage="wpforms-28835-field_58_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_58_4">Oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_58_5" name="wpforms[fields][58]" value="Sehr oft" aria-errormessage="wpforms-28835-field_58_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_58_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_55-container" class="wpforms-field wpforms-field-number" data-field-id="55"><label class="wpforms-field-label" for="wpforms-28835-field_55">Wieviel Wasser und/oder ungesüssten Tee trinken Sie pro Tag? (Angabe in
Liter) <span class="wpforms-required-label" aria-hidden="true">*</span></label><input type="number" id="wpforms-28835-field_55" class="wpforms-field-medium wpforms-field-required" name="wpforms[fields][55]"
aria-errormessage="wpforms-28835-field_55-error" required=""></div>
<div id="wpforms-28835-field_56-container" class="wpforms-field wpforms-field-likert_scale" data-field-id="56">
<fieldset>
<legend class="wpforms-field-label">Wie oft trinken Sie zusätzlich folgende Getränke <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<table cellspacing="0" cellpadding="0" class="wpforms-field-large modern">
<thead>
<tr>
<th style="width:20%;"></th>
<th style="width:16%;">Nie</th>
<th style="width:16%;">Seltener als 1-mal pro Woche</th>
<th style="width:16%;">Ca. 1-mal pro Woche</th>
<th style="width:16%;">Mehrmals pro Woche</th>
<th style="width:16%;">Täglich</th>
</tr>
</thead>
<tbody>
<tr>
<th>Gesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Nie</span><input type="radio" id="wpforms-28835-field_56_1_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][1]" value="1" aria-errormessage="wpforms-28835-field_56_1_1-error" required=""><label
for="wpforms-28835-field_56_1_1"><span class="wpforms-screen-reader-element">Gesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Nie</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Seltener als 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_56_1_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][1]" value="2" aria-errormessage="wpforms-28835-field_56_1_2-error" required=""><label
for="wpforms-28835-field_56_1_2"><span class="wpforms-screen-reader-element">Gesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Seltener als 1-mal pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Ca. 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_56_1_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][1]" value="3" aria-errormessage="wpforms-28835-field_56_1_3-error" required=""><label
for="wpforms-28835-field_56_1_3"><span class="wpforms-screen-reader-element">Gesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Ca. 1-mal pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals pro Woche</span><input type="radio" id="wpforms-28835-field_56_1_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][1]" value="4" aria-errormessage="wpforms-28835-field_56_1_4-error" required=""><label
for="wpforms-28835-field_56_1_4"><span class="wpforms-screen-reader-element">Gesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Mehrmals pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Täglich</span><input type="radio" id="wpforms-28835-field_56_1_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][1]" value="5" aria-errormessage="wpforms-28835-field_56_1_5-error" required=""><label
for="wpforms-28835-field_56_1_5"><span class="wpforms-screen-reader-element">Gesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Täglich</span></label></div>
</td>
</tr>
<tr>
<th>Alkoholische Getränke</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Nie</span><input type="radio" id="wpforms-28835-field_56_2_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][2]" value="1" aria-errormessage="wpforms-28835-field_56_2_1-error" required=""><label
for="wpforms-28835-field_56_2_1"><span class="wpforms-screen-reader-element">Alkoholische Getränke Nie</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Seltener als 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_56_2_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][2]" value="2" aria-errormessage="wpforms-28835-field_56_2_2-error" required=""><label
for="wpforms-28835-field_56_2_2"><span class="wpforms-screen-reader-element">Alkoholische Getränke Seltener als 1-mal pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Ca. 1-mal pro Woche</span><input type="radio" id="wpforms-28835-field_56_2_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][2]" value="3" aria-errormessage="wpforms-28835-field_56_2_3-error" required=""><label
for="wpforms-28835-field_56_2_3"><span class="wpforms-screen-reader-element">Alkoholische Getränke Ca. 1-mal pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Mehrmals pro Woche</span><input type="radio" id="wpforms-28835-field_56_2_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][2]" value="4" aria-errormessage="wpforms-28835-field_56_2_4-error" required=""><label
for="wpforms-28835-field_56_2_4"><span class="wpforms-screen-reader-element">Alkoholische Getränke Mehrmals pro Woche</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">Täglich</span><input type="radio" id="wpforms-28835-field_56_2_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][56][2]" value="5" aria-errormessage="wpforms-28835-field_56_2_5-error" required=""><label
for="wpforms-28835-field_56_2_5"><span class="wpforms-screen-reader-element">Alkoholische Getränke Täglich</span></label></div>
</td>
</tr>
</tbody>
</table>
</fieldset>
</div>
<div id="wpforms-28835-field_59-container" class="wpforms-field wpforms-field-radio" data-field-id="59">
<fieldset>
<legend class="wpforms-field-label">Wie gross schätzen Sie Ihr Wissen in Bezug auf eine gesunde Ernährung, Nährstoffbedarfe des Körpers und Inhaltstoffe von Speisen ein? <span class="wpforms-required-label" aria-hidden="true">*</span>
</legend>
<ul id="wpforms-28835-field_59" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_59_1" name="wpforms[fields][59]" value="Sehr kleines Wissen" aria-errormessage="wpforms-28835-field_59_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_59_1">Sehr kleines Wissen</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_59_2" name="wpforms[fields][59]" value="Kleines Wissen" aria-errormessage="wpforms-28835-field_59_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_59_2">Kleines Wissen</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_59_3" name="wpforms[fields][59]" value="Mittelmässig" aria-errormessage="wpforms-28835-field_59_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_59_3">Mittelmässig</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_59_4" name="wpforms[fields][59]" value="Grosses Wissen" aria-errormessage="wpforms-28835-field_59_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_59_4">Grosses Wissen</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_59_5" name="wpforms[fields][59]" value="Sehr grosses Wissen" aria-errormessage="wpforms-28835-field_59_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_59_5">Sehr grosses Wissen</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_60-container" class="wpforms-field wpforms-field-radio" data-field-id="60">
<fieldset>
<legend class="wpforms-field-label">Verspüren Sie Hungerattacken oder Gelüste? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_60" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_60_1" name="wpforms[fields][60]" value="Nie" aria-errormessage="wpforms-28835-field_60_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_60_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_60_2" name="wpforms[fields][60]" value="Selten" aria-errormessage="wpforms-28835-field_60_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_60_2">Selten</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_60_3" name="wpforms[fields][60]" value="Manchmal" aria-errormessage="wpforms-28835-field_60_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_60_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_60_4" name="wpforms[fields][60]" value="Oft" aria-errormessage="wpforms-28835-field_60_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_60_4">Oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_60_5" name="wpforms[fields][60]" value="Sehr oft" aria-errormessage="wpforms-28835-field_60_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_60_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_61-container" class="wpforms-field wpforms-field-radio wpforms-conditional-trigger" data-field-id="61">
<fieldset>
<legend class="wpforms-field-label">Leiden Sie unter Verdauungsproblemen? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_61" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_61_1" name="wpforms[fields][61]" value="Nie" aria-errormessage="wpforms-28835-field_61_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_61_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_61_2" name="wpforms[fields][61]" value="Selten" aria-errormessage="wpforms-28835-field_61_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_61_2">Selten</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_61_3" name="wpforms[fields][61]" value="Manchmal" aria-errormessage="wpforms-28835-field_61_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_61_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_61_4" name="wpforms[fields][61]" value="Oft" aria-errormessage="wpforms-28835-field_61_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_61_4">Oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_61_5" name="wpforms[fields][61]" value="Sehr oft" aria-errormessage="wpforms-28835-field_61_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_61_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_62-container" class="wpforms-field wpforms-field-checkbox wpforms-conditional-field wpforms-conditional-show" data-field-id="62" style="">
<fieldset>
<legend class="wpforms-field-label">Unter welchen Verdauungsproblemen leiden Sie? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_62" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="checkbox" id="wpforms-28835-field_62_1" name="wpforms[fields][62][]" value="Gasbildung" aria-errormessage="wpforms-28835-field_62_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_62_1">Gasbildung</label></li>
<li class="choice-2 depth-1"><input type="checkbox" id="wpforms-28835-field_62_2" name="wpforms[fields][62][]" value="Verstopfung" aria-errormessage="wpforms-28835-field_62_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_62_2">Verstopfung</label></li>
<li class="choice-3 depth-1"><input type="checkbox" id="wpforms-28835-field_62_3" name="wpforms[fields][62][]" value="Durchfall" aria-errormessage="wpforms-28835-field_62_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_62_3">Durchfall</label></li>
<li class="choice-4 depth-1"><input type="checkbox" id="wpforms-28835-field_62_4" name="wpforms[fields][62][]" value="Magenschmerzen" aria-errormessage="wpforms-28835-field_62_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_62_4">Magenschmerzen</label></li>
<li class="choice-5 depth-1"><input type="checkbox" id="wpforms-28835-field_62_5" name="wpforms[fields][62][]" value="Krämpfe" aria-errormessage="wpforms-28835-field_62_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_62_5">Krämpfe</label></li>
<li class="choice-6 depth-1"><input type="checkbox" id="wpforms-28835-field_62_6" name="wpforms[fields][62][]" value="Übelkeit" aria-errormessage="wpforms-28835-field_62_6-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_62_6">Übelkeit</label></li>
<li class="choice-7 depth-1"><input type="checkbox" id="wpforms-28835-field_62_7" name="wpforms[fields][62][]" value="Sonstiges" aria-errormessage="wpforms-28835-field_62_7-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_62_7">Sonstiges</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_79-container" class="wpforms-field wpforms-field-radio" data-field-id="79">
<fieldset>
<legend class="wpforms-field-label">Wie oft hatten Sie im letzten Monat das Gefühl, nicht in der Lage zu sein, die wichtigen Dinge in Ihrem Leben kontrollieren zu können? <span class="wpforms-required-label" aria-hidden="true">*</span>
</legend>
<ul id="wpforms-28835-field_79" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_79_1" name="wpforms[fields][79]" value="Nie" aria-errormessage="wpforms-28835-field_79_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_79_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_79_2" name="wpforms[fields][79]" value="Fast nie" aria-errormessage="wpforms-28835-field_79_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_79_2">Fast nie</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_79_3" name="wpforms[fields][79]" value="Manchmal" aria-errormessage="wpforms-28835-field_79_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_79_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_79_4" name="wpforms[fields][79]" value="Ziemlich oft" aria-errormessage="wpforms-28835-field_79_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_79_4">Ziemlich oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_79_5" name="wpforms[fields][79]" value="Sehr oft" aria-errormessage="wpforms-28835-field_79_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_79_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_80-container" class="wpforms-field wpforms-field-radio" data-field-id="80">
<fieldset>
<legend class="wpforms-field-label">Wie oft waren Sie im letzten Monat zuversichtlich, dass Sie fähig sind, ihre persönlichen Probleme zu bewältigen? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_80" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_80_1" name="wpforms[fields][80]" value="Nie" aria-errormessage="wpforms-28835-field_80_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_80_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_80_2" name="wpforms[fields][80]" value="Fast nie" aria-errormessage="wpforms-28835-field_80_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_80_2">Fast nie</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_80_3" name="wpforms[fields][80]" value="Manchmal" aria-errormessage="wpforms-28835-field_80_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_80_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_80_4" name="wpforms[fields][80]" value="Ziemlich oft" aria-errormessage="wpforms-28835-field_80_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_80_4">Ziemlich oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_80_5" name="wpforms[fields][80]" value="Sehr oft" aria-errormessage="wpforms-28835-field_80_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_80_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_81-container" class="wpforms-field wpforms-field-radio" data-field-id="81">
<fieldset>
<legend class="wpforms-field-label">Wie oft hatten Sie im letzten Monat das Gefühl, dass sich die Dinge zu Ihren Gunsten entwickeln? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_81" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_81_1" name="wpforms[fields][81]" value="Nie" aria-errormessage="wpforms-28835-field_81_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_81_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_81_2" name="wpforms[fields][81]" value="Fast nie" aria-errormessage="wpforms-28835-field_81_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_81_2">Fast nie</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_81_3" name="wpforms[fields][81]" value="Manchmal" aria-errormessage="wpforms-28835-field_81_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_81_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_81_4" name="wpforms[fields][81]" value="Ziemlich oft" aria-errormessage="wpforms-28835-field_81_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_81_4">Ziemlich oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_81_5" name="wpforms[fields][81]" value="Sehr oft" aria-errormessage="wpforms-28835-field_81_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_81_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_82-container" class="wpforms-field wpforms-field-radio" data-field-id="82">
<fieldset>
<legend class="wpforms-field-label">Wie oft hatten Sie im letzten Monat das Gefühl, dass sich so viele Schwierigkeiten angehäuft haben, dass Sie diese nicht überwinden konnten? <span class="wpforms-required-label"
aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_82" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_82_1" name="wpforms[fields][82]" value="Nie" aria-errormessage="wpforms-28835-field_82_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_82_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_82_2" name="wpforms[fields][82]" value="Fast nie" aria-errormessage="wpforms-28835-field_82_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_82_2">Fast nie</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_82_3" name="wpforms[fields][82]" value="Manchmal" aria-errormessage="wpforms-28835-field_82_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_82_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_82_4" name="wpforms[fields][82]" value="Ziemlich oft" aria-errormessage="wpforms-28835-field_82_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_82_4">Ziemlich oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_82_5" name="wpforms[fields][82]" value="Sehr oft" aria-errormessage="wpforms-28835-field_82_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_82_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_83-container" class="wpforms-field wpforms-field-radio" data-field-id="83">
<fieldset>
<legend class="wpforms-field-label">Wie oft haben Sie sich im letzten Monat nervös und "gestresst" gefühlt? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_83" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_83_1" name="wpforms[fields][83]" value="Nie" aria-errormessage="wpforms-28835-field_83_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_83_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_83_2" name="wpforms[fields][83]" value="Fast nie" aria-errormessage="wpforms-28835-field_83_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_83_2">Fast nie</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_83_3" name="wpforms[fields][83]" value="Manchmal" aria-errormessage="wpforms-28835-field_83_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_83_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_83_4" name="wpforms[fields][83]" value="Ziemlich oft" aria-errormessage="wpforms-28835-field_83_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_83_4">Ziemlich oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_83_5" name="wpforms[fields][83]" value="Sehr oft" aria-errormessage="wpforms-28835-field_83_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_83_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_84-container" class="wpforms-field wpforms-field-radio" data-field-id="84">
<fieldset>
<legend class="wpforms-field-label">Fühlen Sie sich öfters einsam? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_84" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_84_1" name="wpforms[fields][84]" value="Nie" aria-errormessage="wpforms-28835-field_84_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_84_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_84_2" name="wpforms[fields][84]" value="Fast nie" aria-errormessage="wpforms-28835-field_84_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_84_2">Fast nie</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_84_3" name="wpforms[fields][84]" value="Manchmal" aria-errormessage="wpforms-28835-field_84_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_84_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_84_4" name="wpforms[fields][84]" value="Ziemlich oft" aria-errormessage="wpforms-28835-field_84_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_84_4">Ziemlich oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_84_5" name="wpforms[fields][84]" value="Sehr oft" aria-errormessage="wpforms-28835-field_84_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_84_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_65-container" class="wpforms-field wpforms-field-likert_scale" data-field-id="65">
<fieldset>
<legend class="wpforms-field-label">Wie schätzen Sie Ihre aktuelle Produktivität in Bezug auf berufliche Herausforderungen auf einer Skala von 1-10 ein? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<table cellspacing="0" cellpadding="0" class="wpforms-field-large modern single-row">
<thead>
<tr>
<th style="width:10%;">1</th>
<th style="width:10%;">2</th>
<th style="width:10%;">3</th>
<th style="width:10%;">4</th>
<th style="width:10%;">5</th>
<th style="width:10%;">6</th>
<th style="width:10%;">7</th>
<th style="width:10%;">8</th>
<th style="width:10%;">9</th>
<th style="width:10%;">10</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_65_1_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="1" aria-errormessage="wpforms-28835-field_65_1_1-error" required=""><label
for="wpforms-28835-field_65_1_1"><span class="wpforms-screen-reader-element">Fitnesslevel 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_65_1_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="2" aria-errormessage="wpforms-28835-field_65_1_2-error" required=""><label
for="wpforms-28835-field_65_1_2"><span class="wpforms-screen-reader-element">Fitnesslevel 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_65_1_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="3" aria-errormessage="wpforms-28835-field_65_1_3-error" required=""><label
for="wpforms-28835-field_65_1_3"><span class="wpforms-screen-reader-element">Fitnesslevel 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_65_1_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="4" aria-errormessage="wpforms-28835-field_65_1_4-error" required=""><label
for="wpforms-28835-field_65_1_4"><span class="wpforms-screen-reader-element">Fitnesslevel 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_65_1_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="5" aria-errormessage="wpforms-28835-field_65_1_5-error" required=""><label
for="wpforms-28835-field_65_1_5"><span class="wpforms-screen-reader-element">Fitnesslevel 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_65_1_6"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="6" aria-errormessage="wpforms-28835-field_65_1_6-error" required=""><label
for="wpforms-28835-field_65_1_6"><span class="wpforms-screen-reader-element">Fitnesslevel 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_65_1_7"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="7" aria-errormessage="wpforms-28835-field_65_1_7-error" required=""><label
for="wpforms-28835-field_65_1_7"><span class="wpforms-screen-reader-element">Fitnesslevel 7</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">8</span><input type="radio" id="wpforms-28835-field_65_1_8"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="8" aria-errormessage="wpforms-28835-field_65_1_8-error" required=""><label
for="wpforms-28835-field_65_1_8"><span class="wpforms-screen-reader-element">Fitnesslevel 8</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">9</span><input type="radio" id="wpforms-28835-field_65_1_9"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="9" aria-errormessage="wpforms-28835-field_65_1_9-error" required=""><label
for="wpforms-28835-field_65_1_9"><span class="wpforms-screen-reader-element">Fitnesslevel 9</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">10</span><input type="radio" id="wpforms-28835-field_65_1_10"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][65][1]" value="10" aria-errormessage="wpforms-28835-field_65_1_10-error" required=""><label
for="wpforms-28835-field_65_1_10"><span class="wpforms-screen-reader-element">Fitnesslevel 10</span></label></div>
</td>
</tr>
</tbody>
</table>
</fieldset>
</div>
<div id="wpforms-28835-field_66-container" class="wpforms-field wpforms-field-radio" data-field-id="66">
<fieldset>
<legend class="wpforms-field-label">Wann sind Sie im letzten Monat normalerweise zu Bett gegangen? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_66" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_66_1" name="wpforms[fields][66]" value="Vor 21:00 Uhr" aria-errormessage="wpforms-28835-field_66_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_66_1">Vor 21:00 Uhr</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_66_2" name="wpforms[fields][66]" value="Zwischen 21:00 und 23:00 Uhr" aria-errormessage="wpforms-28835-field_66_2-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_66_2">Zwischen 21:00 und 23:00 Uhr</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_66_3" name="wpforms[fields][66]" value="Zwischen 23:00 und 01:00 Uhr" aria-errormessage="wpforms-28835-field_66_3-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_66_3">Zwischen 23:00 und 01:00 Uhr</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_66_4" name="wpforms[fields][66]" value="Zwischen 01:00 und 02:00 Uhr" aria-errormessage="wpforms-28835-field_66_4-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_66_4">Zwischen 01:00 und 02:00 Uhr</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_66_5" name="wpforms[fields][66]" value="Nach 02:00 Uhr" aria-errormessage="wpforms-28835-field_66_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_66_5">Nach 02:00 Uhr</label></li>
<li class="choice-6 depth-1"><input type="radio" id="wpforms-28835-field_66_6" name="wpforms[fields][66]" value="Verschieden / Ich arbeite Schichtarbeit" aria-errormessage="wpforms-28835-field_66_6-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_66_6">Verschieden / Ich arbeite Schichtarbeit</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_67-container" class="wpforms-field wpforms-field-radio" data-field-id="67">
<fieldset>
<legend class="wpforms-field-label">Wann sind Sie im letzten Monat normalerweise aufgestanden? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_67" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_67_1" name="wpforms[fields][67]" value="Vor 05:00 Uhr" aria-errormessage="wpforms-28835-field_67_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_67_1">Vor 05:00 Uhr</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_67_2" name="wpforms[fields][67]" value="Zwischen 05:00 und 06:00 Uhr" aria-errormessage="wpforms-28835-field_67_2-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_67_2">Zwischen 05:00 und 06:00 Uhr</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_67_3" name="wpforms[fields][67]" value="Zwischen 06:00 und 07:00 Uhr" aria-errormessage="wpforms-28835-field_67_3-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_67_3">Zwischen 06:00 und 07:00 Uhr</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_67_4" name="wpforms[fields][67]" value="Zwischen 07:00 und 08:00 Uhr" aria-errormessage="wpforms-28835-field_67_4-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_67_4">Zwischen 07:00 und 08:00 Uhr</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_67_5" name="wpforms[fields][67]" value="Zwischen 08:00 und 09:00 Uhr" aria-errormessage="wpforms-28835-field_67_5-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_67_5">Zwischen 08:00 und 09:00 Uhr</label></li>
<li class="choice-6 depth-1"><input type="radio" id="wpforms-28835-field_67_6" name="wpforms[fields][67]" value="Nach 09:00 Uhr" aria-errormessage="wpforms-28835-field_67_6-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_67_6">Nach 09:00 Uhr</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_68-container" class="wpforms-field wpforms-field-radio" data-field-id="68">
<fieldset>
<legend class="wpforms-field-label">Wie lange hat es Sie im letzten Monat im normalerweise gedauert, bis Sie nach dem zu Bett gehen eingeschlafen sind? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_68" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_68_1" name="wpforms[fields][68]" value="Weniger als 5 Minuten" aria-errormessage="wpforms-28835-field_68_1-error" required=""><label
class="wpforms-field-label-inline" for="wpforms-28835-field_68_1">Weniger als 5 Minuten</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_68_2" name="wpforms[fields][68]" value="5-15 Minuten" aria-errormessage="wpforms-28835-field_68_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_68_2">5-15 Minuten</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_68_3" name="wpforms[fields][68]" value="16-30 Minuten" aria-errormessage="wpforms-28835-field_68_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_68_3">16-30 Minuten</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_68_4" name="wpforms[fields][68]" value="31-60 Minuten" aria-errormessage="wpforms-28835-field_68_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_68_4">31-60 Minuten</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_68_5" name="wpforms[fields][68]" value="Mehr als 1 Stunde" aria-errormessage="wpforms-28835-field_68_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_68_5">Mehr als 1 Stunde</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_69-container" class="wpforms-field wpforms-field-radio" data-field-id="69">
<fieldset>
<legend class="wpforms-field-label">Im letzten Monat, wie viele Stunden haben Sie im Durchschnitt effektiv geschlafen pro Nacht? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_69" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_69_1" name="wpforms[fields][69]" value="2-3" aria-errormessage="wpforms-28835-field_69_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_69_1">2-3</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_69_2" name="wpforms[fields][69]" value="4-5" aria-errormessage="wpforms-28835-field_69_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_69_2">4-5</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_69_3" name="wpforms[fields][69]" value="6-7" aria-errormessage="wpforms-28835-field_69_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_69_3">6-7</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_69_4" name="wpforms[fields][69]" value="8-9" aria-errormessage="wpforms-28835-field_69_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_69_4">8-9</label></li>
<li class="choice-6 depth-1"><input type="radio" id="wpforms-28835-field_69_6" name="wpforms[fields][69]" value="10-12" aria-errormessage="wpforms-28835-field_69_6-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_69_6">10-12</label></li>
<li class="choice-7 depth-1"><input type="radio" id="wpforms-28835-field_69_7" name="wpforms[fields][69]" value="Mehr als 12" aria-errormessage="wpforms-28835-field_69_7-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_69_7">Mehr als 12</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_70-container" class="wpforms-field wpforms-field-radio" data-field-id="70">
<fieldset>
<legend class="wpforms-field-label">Im letzten Monat, wie oft wurde Ihr Schlaf dadurch gestört, dass Sie mitten in der Nacht oder frühmorgens vor dem Wecker aufgewacht sind? <span class="wpforms-required-label" aria-hidden="true">*</span>
</legend>
<ul id="wpforms-28835-field_70" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_70_1" name="wpforms[fields][70]" value="Nie" aria-errormessage="wpforms-28835-field_70_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_70_1">Nie</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_70_2" name="wpforms[fields][70]" value="Selten" aria-errormessage="wpforms-28835-field_70_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_70_2">Selten</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_70_3" name="wpforms[fields][70]" value="Manchmal" aria-errormessage="wpforms-28835-field_70_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_70_3">Manchmal</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_70_4" name="wpforms[fields][70]" value="Oft" aria-errormessage="wpforms-28835-field_70_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_70_4">Oft</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_70_5" name="wpforms[fields][70]" value="Sehr oft" aria-errormessage="wpforms-28835-field_70_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_70_5">Sehr oft</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_71-container" class="wpforms-field wpforms-field-likert_scale" data-field-id="71">
<fieldset>
<legend class="wpforms-field-label">Wie würden Sie Ihre allgemeine Schlafqualität im letzten Monat bewerten (1= sehr schlecht, 10 = hervorragend) <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<table cellspacing="0" cellpadding="0" class="wpforms-field-large modern single-row">
<thead>
<tr>
<th style="width:10%;">1</th>
<th style="width:10%;">2</th>
<th style="width:10%;">3</th>
<th style="width:10%;">4</th>
<th style="width:10%;">5</th>
<th style="width:10%;">6</th>
<th style="width:10%;">7</th>
<th style="width:10%;">8</th>
<th style="width:10%;">9</th>
<th style="width:10%;">10</th>
</tr>
</thead>
<tbody>
<tr>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_71_1_1"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="1" aria-errormessage="wpforms-28835-field_71_1_1-error" required=""><label
for="wpforms-28835-field_71_1_1"><span class="wpforms-screen-reader-element">Fitnesslevel 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_71_1_2"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="2" aria-errormessage="wpforms-28835-field_71_1_2-error" required=""><label
for="wpforms-28835-field_71_1_2"><span class="wpforms-screen-reader-element">Fitnesslevel 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_71_1_3"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="3" aria-errormessage="wpforms-28835-field_71_1_3-error" required=""><label
for="wpforms-28835-field_71_1_3"><span class="wpforms-screen-reader-element">Fitnesslevel 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_71_1_4"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="4" aria-errormessage="wpforms-28835-field_71_1_4-error" required=""><label
for="wpforms-28835-field_71_1_4"><span class="wpforms-screen-reader-element">Fitnesslevel 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_71_1_5"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="5" aria-errormessage="wpforms-28835-field_71_1_5-error" required=""><label
for="wpforms-28835-field_71_1_5"><span class="wpforms-screen-reader-element">Fitnesslevel 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_71_1_6"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="6" aria-errormessage="wpforms-28835-field_71_1_6-error" required=""><label
for="wpforms-28835-field_71_1_6"><span class="wpforms-screen-reader-element">Fitnesslevel 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_71_1_7"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="7" aria-errormessage="wpforms-28835-field_71_1_7-error" required=""><label
for="wpforms-28835-field_71_1_7"><span class="wpforms-screen-reader-element">Fitnesslevel 7</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">8</span><input type="radio" id="wpforms-28835-field_71_1_8"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="8" aria-errormessage="wpforms-28835-field_71_1_8-error" required=""><label
for="wpforms-28835-field_71_1_8"><span class="wpforms-screen-reader-element">Fitnesslevel 8</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">9</span><input type="radio" id="wpforms-28835-field_71_1_9"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="9" aria-errormessage="wpforms-28835-field_71_1_9-error" required=""><label
for="wpforms-28835-field_71_1_9"><span class="wpforms-screen-reader-element">Fitnesslevel 9</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">10</span><input type="radio" id="wpforms-28835-field_71_1_10"
class="wpforms-screen-reader-element wpforms-likert-scale-option wpforms-field-required" name="wpforms[fields][71][1]" value="10" aria-errormessage="wpforms-28835-field_71_1_10-error" required=""><label
for="wpforms-28835-field_71_1_10"><span class="wpforms-screen-reader-element">Fitnesslevel 10</span></label></div>
</td>
</tr>
</tbody>
</table>
</fieldset>
</div>
<div id="wpforms-28835-field_72-container" class="wpforms-field wpforms-field-radio" data-field-id="72">
<fieldset>
<legend class="wpforms-field-label">Wie stark ist Ihre Leistungsfähigkeit tagsüber durch einen schlechten Schlaf beeinträchtigt? <span class="wpforms-required-label" aria-hidden="true">*</span></legend>
<ul id="wpforms-28835-field_72" class="wpforms-field-required">
<li class="choice-1 depth-1"><input type="radio" id="wpforms-28835-field_72_1" name="wpforms[fields][72]" value="Gar nicht" aria-errormessage="wpforms-28835-field_72_1-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_72_1">Gar nicht</label></li>
<li class="choice-2 depth-1"><input type="radio" id="wpforms-28835-field_72_2" name="wpforms[fields][72]" value="Ein wenig" aria-errormessage="wpforms-28835-field_72_2-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_72_2">Ein wenig</label></li>
<li class="choice-3 depth-1"><input type="radio" id="wpforms-28835-field_72_3" name="wpforms[fields][72]" value="Mal so mal so" aria-errormessage="wpforms-28835-field_72_3-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_72_3">Mal so mal so</label></li>
<li class="choice-4 depth-1"><input type="radio" id="wpforms-28835-field_72_4" name="wpforms[fields][72]" value="Ziemlich" aria-errormessage="wpforms-28835-field_72_4-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_72_4">Ziemlich</label></li>
<li class="choice-5 depth-1"><input type="radio" id="wpforms-28835-field_72_5" name="wpforms[fields][72]" value="Sehr stark" aria-errormessage="wpforms-28835-field_72_5-error" required=""><label class="wpforms-field-label-inline"
for="wpforms-28835-field_72_5">Sehr stark</label></li>
</ul>
</fieldset>
</div>
<div id="wpforms-28835-field_74-container" class="wpforms-field wpforms-field-pagebreak" data-field-id="74">
<div class="wpforms-clear wpforms-pagebreak-left"><button class="wpforms-page-button wpforms-page-prev" data-action="prev" data-page="3" data-formid="28835" aria-disabled="false" aria-describedby="">Zurück</button><button
class="wpforms-page-button wpforms-page-next" data-action="next" data-page="3" data-formid="28835" aria-disabled="false"
aria-describedby="">Weiter</button><a href="#" class="wpforms-save-resume-button"><span>Speichern und später fortsetzen</span></a></div>
</div>
</div>
<div class="wpforms-page wpforms-page-4 last " data-page="4" style="display:none;">
<div id="wpforms-28835-field_73-container" class="wpforms-field wpforms-field-divider" data-field-id="73">
<h3 id="wpforms-28835-field_73" aria-errormessage="wpforms-28835-field_73-error" aria-describedby="wpforms-28835-field_73-description">Schlussspurt</h3>
<div id="wpforms-28835-field_73-description" class="wpforms-field-description">Bald haben Sie es geschafft!</div>
</div>
<div id="wpforms-28835-field_1-container" class="wpforms-field wpforms-field-text" data-field-type="text" data-field-id="1">
<label class="wpforms-field-label" for="wpforms-28835-field_1" aria-hidden="true">gestört, schätzen hervorragend)</label>
<input type="text" id="wpforms-28835-field_1" class="wpforms-field-medium" name="wpforms[fields][1]" tabindex="-1" aria-hidden="true">
</div>
<div id="wpforms-28835-field_76-container" class="wpforms-field wpforms-field-likert_scale" data-field-id="76">
<fieldset>
<legend class="wpforms-field-label">Beantworten Sie die letzten Fragen bitte auf einer Skala von 1-7.</legend>
<table cellspacing="0" cellpadding="0" class="wpforms-field-large modern">
<thead>
<tr>
<th style="width:20%;"></th>
<th style="width:11%;">1</th>
<th style="width:11%;">2</th>
<th style="width:11%;">3</th>
<th style="width:11%;">4</th>
<th style="width:11%;">5</th>
<th style="width:11%;">6</th>
<th style="width:11%;">7</th>
</tr>
</thead>
<tbody>
<tr>
<th>Wenn ich Pläne habe, verfolge ich Sie auch.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_1_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][1]" value="1" aria-errormessage="wpforms-28835-field_76_1_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_1_1"><span
class="wpforms-screen-reader-element">Wenn ich Pläne habe, verfolge ich Sie auch. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_1_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][1]" value="2" aria-errormessage="wpforms-28835-field_76_1_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_1_2"><span
class="wpforms-screen-reader-element">Wenn ich Pläne habe, verfolge ich Sie auch. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_1_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][1]" value="3" aria-errormessage="wpforms-28835-field_76_1_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_1_3"><span
class="wpforms-screen-reader-element">Wenn ich Pläne habe, verfolge ich Sie auch. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_1_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][1]" value="4" aria-errormessage="wpforms-28835-field_76_1_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_1_4"><span
class="wpforms-screen-reader-element">Wenn ich Pläne habe, verfolge ich Sie auch. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_1_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][1]" value="5" aria-errormessage="wpforms-28835-field_76_1_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_1_5"><span
class="wpforms-screen-reader-element">Wenn ich Pläne habe, verfolge ich Sie auch. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_1_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][1]" value="6" aria-errormessage="wpforms-28835-field_76_1_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_1_6"><span
class="wpforms-screen-reader-element">Wenn ich Pläne habe, verfolge ich Sie auch. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_1_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][1]" value="7" aria-errormessage="wpforms-28835-field_76_1_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_1_7"><span
class="wpforms-screen-reader-element">Wenn ich Pläne habe, verfolge ich Sie auch. 7</span></label></div>
</td>
</tr>
<tr>
<th>Normalerweise schaffe ich alles irgendwie.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_2_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][2]" value="1" aria-errormessage="wpforms-28835-field_76_2_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_2_1"><span
class="wpforms-screen-reader-element">Normalerweise schaffe ich alles irgendwie. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_2_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][2]" value="2" aria-errormessage="wpforms-28835-field_76_2_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_2_2"><span
class="wpforms-screen-reader-element">Normalerweise schaffe ich alles irgendwie. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_2_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][2]" value="3" aria-errormessage="wpforms-28835-field_76_2_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_2_3"><span
class="wpforms-screen-reader-element">Normalerweise schaffe ich alles irgendwie. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_2_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][2]" value="4" aria-errormessage="wpforms-28835-field_76_2_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_2_4"><span
class="wpforms-screen-reader-element">Normalerweise schaffe ich alles irgendwie. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_2_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][2]" value="5" aria-errormessage="wpforms-28835-field_76_2_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_2_5"><span
class="wpforms-screen-reader-element">Normalerweise schaffe ich alles irgendwie. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_2_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][2]" value="6" aria-errormessage="wpforms-28835-field_76_2_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_2_6"><span
class="wpforms-screen-reader-element">Normalerweise schaffe ich alles irgendwie. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_2_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][2]" value="7" aria-errormessage="wpforms-28835-field_76_2_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_2_7"><span
class="wpforms-screen-reader-element">Normalerweise schaffe ich alles irgendwie. 7</span></label></div>
</td>
</tr>
<tr>
<th>Ich lasse mich nicht so schnell aus der Bahn werfen.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_3_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][3]" value="1" aria-errormessage="wpforms-28835-field_76_3_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_3_1"><span
class="wpforms-screen-reader-element">Ich lasse mich nicht so schnell aus der Bahn werfen. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_3_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][3]" value="2" aria-errormessage="wpforms-28835-field_76_3_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_3_2"><span
class="wpforms-screen-reader-element">Ich lasse mich nicht so schnell aus der Bahn werfen. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_3_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][3]" value="3" aria-errormessage="wpforms-28835-field_76_3_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_3_3"><span
class="wpforms-screen-reader-element">Ich lasse mich nicht so schnell aus der Bahn werfen. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_3_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][3]" value="4" aria-errormessage="wpforms-28835-field_76_3_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_3_4"><span
class="wpforms-screen-reader-element">Ich lasse mich nicht so schnell aus der Bahn werfen. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_3_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][3]" value="5" aria-errormessage="wpforms-28835-field_76_3_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_3_5"><span
class="wpforms-screen-reader-element">Ich lasse mich nicht so schnell aus der Bahn werfen. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_3_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][3]" value="6" aria-errormessage="wpforms-28835-field_76_3_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_3_6"><span
class="wpforms-screen-reader-element">Ich lasse mich nicht so schnell aus der Bahn werfen. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_3_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][3]" value="7" aria-errormessage="wpforms-28835-field_76_3_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_3_7"><span
class="wpforms-screen-reader-element">Ich lasse mich nicht so schnell aus der Bahn werfen. 7</span></label></div>
</td>
</tr>
<tr>
<th>Ich mag mich.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_4_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][4]" value="1" aria-errormessage="wpforms-28835-field_76_4_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_4_1"><span
class="wpforms-screen-reader-element">Ich mag mich. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_4_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][4]" value="2" aria-errormessage="wpforms-28835-field_76_4_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_4_2"><span
class="wpforms-screen-reader-element">Ich mag mich. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_4_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][4]" value="3" aria-errormessage="wpforms-28835-field_76_4_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_4_3"><span
class="wpforms-screen-reader-element">Ich mag mich. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_4_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][4]" value="4" aria-errormessage="wpforms-28835-field_76_4_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_4_4"><span
class="wpforms-screen-reader-element">Ich mag mich. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_4_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][4]" value="5" aria-errormessage="wpforms-28835-field_76_4_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_4_5"><span
class="wpforms-screen-reader-element">Ich mag mich. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_4_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][4]" value="6" aria-errormessage="wpforms-28835-field_76_4_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_4_6"><span
class="wpforms-screen-reader-element">Ich mag mich. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_4_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][4]" value="7" aria-errormessage="wpforms-28835-field_76_4_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_4_7"><span
class="wpforms-screen-reader-element">Ich mag mich. 7</span></label></div>
</td>
</tr>
<tr>
<th>Ich kann mehrere Dinge gleichzeitig bewältigen.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_5_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][5]" value="1" aria-errormessage="wpforms-28835-field_76_5_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_5_1"><span
class="wpforms-screen-reader-element">Ich kann mehrere Dinge gleichzeitig bewältigen. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_5_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][5]" value="2" aria-errormessage="wpforms-28835-field_76_5_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_5_2"><span
class="wpforms-screen-reader-element">Ich kann mehrere Dinge gleichzeitig bewältigen. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_5_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][5]" value="3" aria-errormessage="wpforms-28835-field_76_5_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_5_3"><span
class="wpforms-screen-reader-element">Ich kann mehrere Dinge gleichzeitig bewältigen. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_5_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][5]" value="4" aria-errormessage="wpforms-28835-field_76_5_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_5_4"><span
class="wpforms-screen-reader-element">Ich kann mehrere Dinge gleichzeitig bewältigen. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_5_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][5]" value="5" aria-errormessage="wpforms-28835-field_76_5_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_5_5"><span
class="wpforms-screen-reader-element">Ich kann mehrere Dinge gleichzeitig bewältigen. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_5_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][5]" value="6" aria-errormessage="wpforms-28835-field_76_5_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_5_6"><span
class="wpforms-screen-reader-element">Ich kann mehrere Dinge gleichzeitig bewältigen. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_5_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][5]" value="7" aria-errormessage="wpforms-28835-field_76_5_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_5_7"><span
class="wpforms-screen-reader-element">Ich kann mehrere Dinge gleichzeitig bewältigen. 7</span></label></div>
</td>
</tr>
<tr>
<th>Ich bin entschlossen.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_6_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][6]" value="1" aria-errormessage="wpforms-28835-field_76_6_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_6_1"><span
class="wpforms-screen-reader-element">Ich bin entschlossen. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_6_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][6]" value="2" aria-errormessage="wpforms-28835-field_76_6_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_6_2"><span
class="wpforms-screen-reader-element">Ich bin entschlossen. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_6_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][6]" value="3" aria-errormessage="wpforms-28835-field_76_6_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_6_3"><span
class="wpforms-screen-reader-element">Ich bin entschlossen. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_6_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][6]" value="4" aria-errormessage="wpforms-28835-field_76_6_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_6_4"><span
class="wpforms-screen-reader-element">Ich bin entschlossen. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_6_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][6]" value="5" aria-errormessage="wpforms-28835-field_76_6_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_6_5"><span
class="wpforms-screen-reader-element">Ich bin entschlossen. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_6_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][6]" value="6" aria-errormessage="wpforms-28835-field_76_6_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_6_6"><span
class="wpforms-screen-reader-element">Ich bin entschlossen. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_6_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][6]" value="7" aria-errormessage="wpforms-28835-field_76_6_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_6_7"><span
class="wpforms-screen-reader-element">Ich bin entschlossen. 7</span></label></div>
</td>
</tr>
<tr>
<th>Ich nehme die Dinge wie sie kommen.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_7_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][7]" value="1" aria-errormessage="wpforms-28835-field_76_7_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_7_1"><span
class="wpforms-screen-reader-element">Ich nehme die Dinge wie sie kommen. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_7_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][7]" value="2" aria-errormessage="wpforms-28835-field_76_7_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_7_2"><span
class="wpforms-screen-reader-element">Ich nehme die Dinge wie sie kommen. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_7_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][7]" value="3" aria-errormessage="wpforms-28835-field_76_7_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_7_3"><span
class="wpforms-screen-reader-element">Ich nehme die Dinge wie sie kommen. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_7_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][7]" value="4" aria-errormessage="wpforms-28835-field_76_7_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_7_4"><span
class="wpforms-screen-reader-element">Ich nehme die Dinge wie sie kommen. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_7_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][7]" value="5" aria-errormessage="wpforms-28835-field_76_7_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_7_5"><span
class="wpforms-screen-reader-element">Ich nehme die Dinge wie sie kommen. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_7_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][7]" value="6" aria-errormessage="wpforms-28835-field_76_7_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_7_6"><span
class="wpforms-screen-reader-element">Ich nehme die Dinge wie sie kommen. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_7_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][7]" value="7" aria-errormessage="wpforms-28835-field_76_7_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_7_7"><span
class="wpforms-screen-reader-element">Ich nehme die Dinge wie sie kommen. 7</span></label></div>
</td>
</tr>
<tr>
<th>Ich behalte an vielen Dingen Interesse.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_8_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][8]" value="1" aria-errormessage="wpforms-28835-field_76_8_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_8_1"><span
class="wpforms-screen-reader-element">Ich behalte an vielen Dingen Interesse. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_8_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][8]" value="2" aria-errormessage="wpforms-28835-field_76_8_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_8_2"><span
class="wpforms-screen-reader-element">Ich behalte an vielen Dingen Interesse. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_8_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][8]" value="3" aria-errormessage="wpforms-28835-field_76_8_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_8_3"><span
class="wpforms-screen-reader-element">Ich behalte an vielen Dingen Interesse. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_8_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][8]" value="4" aria-errormessage="wpforms-28835-field_76_8_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_8_4"><span
class="wpforms-screen-reader-element">Ich behalte an vielen Dingen Interesse. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_8_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][8]" value="5" aria-errormessage="wpforms-28835-field_76_8_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_8_5"><span
class="wpforms-screen-reader-element">Ich behalte an vielen Dingen Interesse. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_8_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][8]" value="6" aria-errormessage="wpforms-28835-field_76_8_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_8_6"><span
class="wpforms-screen-reader-element">Ich behalte an vielen Dingen Interesse. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_8_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][8]" value="7" aria-errormessage="wpforms-28835-field_76_8_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_8_7"><span
class="wpforms-screen-reader-element">Ich behalte an vielen Dingen Interesse. 7</span></label></div>
</td>
</tr>
<tr>
<th>Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_9_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][9]" value="1" aria-errormessage="wpforms-28835-field_76_9_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_9_1"><span
class="wpforms-screen-reader-element">Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_9_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][9]" value="2" aria-errormessage="wpforms-28835-field_76_9_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_9_2"><span
class="wpforms-screen-reader-element">Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_9_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][9]" value="3" aria-errormessage="wpforms-28835-field_76_9_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_9_3"><span
class="wpforms-screen-reader-element">Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_9_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][9]" value="4" aria-errormessage="wpforms-28835-field_76_9_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_9_4"><span
class="wpforms-screen-reader-element">Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_9_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][9]" value="5" aria-errormessage="wpforms-28835-field_76_9_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_9_5"><span
class="wpforms-screen-reader-element">Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_9_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][9]" value="6" aria-errormessage="wpforms-28835-field_76_9_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_9_6"><span
class="wpforms-screen-reader-element">Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_9_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][9]" value="7" aria-errormessage="wpforms-28835-field_76_9_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_9_7"><span
class="wpforms-screen-reader-element">Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 7</span></label></div>
</td>
</tr>
<tr>
<th>Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_10_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][10]" value="1" aria-errormessage="wpforms-28835-field_76_10_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_10_1"><span
class="wpforms-screen-reader-element">Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_10_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][10]" value="2" aria-errormessage="wpforms-28835-field_76_10_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_10_2"><span
class="wpforms-screen-reader-element">Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_10_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][10]" value="3" aria-errormessage="wpforms-28835-field_76_10_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_10_3"><span
class="wpforms-screen-reader-element">Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_10_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][10]" value="4" aria-errormessage="wpforms-28835-field_76_10_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_10_4"><span
class="wpforms-screen-reader-element">Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_10_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][10]" value="5" aria-errormessage="wpforms-28835-field_76_10_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_10_5"><span
class="wpforms-screen-reader-element">Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_10_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][10]" value="6" aria-errormessage="wpforms-28835-field_76_10_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_10_6"><span
class="wpforms-screen-reader-element">Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_10_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][10]" value="7" aria-errormessage="wpforms-28835-field_76_10_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_10_7"><span
class="wpforms-screen-reader-element">Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 7</span></label></div>
</td>
</tr>
<tr>
<th>Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_11_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][11]" value="1" aria-errormessage="wpforms-28835-field_76_11_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_11_1"><span
class="wpforms-screen-reader-element">Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_11_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][11]" value="2" aria-errormessage="wpforms-28835-field_76_11_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_11_2"><span
class="wpforms-screen-reader-element">Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_11_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][11]" value="3" aria-errormessage="wpforms-28835-field_76_11_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_11_3"><span
class="wpforms-screen-reader-element">Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_11_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][11]" value="4" aria-errormessage="wpforms-28835-field_76_11_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_11_4"><span
class="wpforms-screen-reader-element">Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_11_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][11]" value="5" aria-errormessage="wpforms-28835-field_76_11_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_11_5"><span
class="wpforms-screen-reader-element">Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_11_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][11]" value="6" aria-errormessage="wpforms-28835-field_76_11_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_11_6"><span
class="wpforms-screen-reader-element">Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_11_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][11]" value="7" aria-errormessage="wpforms-28835-field_76_11_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_11_7"><span
class="wpforms-screen-reader-element">Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 7</span></label></div>
</td>
</tr>
<tr>
<th>In mir steckt genügend Energie, um alles zu machen was ich machen muss.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_12_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][12]" value="1" aria-errormessage="wpforms-28835-field_76_12_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_12_1"><span
class="wpforms-screen-reader-element">In mir steckt genügend Energie, um alles zu machen was ich machen muss. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_12_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][12]" value="2" aria-errormessage="wpforms-28835-field_76_12_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_12_2"><span
class="wpforms-screen-reader-element">In mir steckt genügend Energie, um alles zu machen was ich machen muss. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_12_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][12]" value="3" aria-errormessage="wpforms-28835-field_76_12_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_12_3"><span
class="wpforms-screen-reader-element">In mir steckt genügend Energie, um alles zu machen was ich machen muss. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_12_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][12]" value="4" aria-errormessage="wpforms-28835-field_76_12_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_12_4"><span
class="wpforms-screen-reader-element">In mir steckt genügend Energie, um alles zu machen was ich machen muss. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_12_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][12]" value="5" aria-errormessage="wpforms-28835-field_76_12_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_12_5"><span
class="wpforms-screen-reader-element">In mir steckt genügend Energie, um alles zu machen was ich machen muss. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_12_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][12]" value="6" aria-errormessage="wpforms-28835-field_76_12_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_12_6"><span
class="wpforms-screen-reader-element">In mir steckt genügend Energie, um alles zu machen was ich machen muss. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_12_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][12]" value="7" aria-errormessage="wpforms-28835-field_76_12_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_12_7"><span
class="wpforms-screen-reader-element">In mir steckt genügend Energie, um alles zu machen was ich machen muss. 7</span></label></div>
</td>
</tr>
<tr>
<th>Ich kann es akzeptieren, wenn mich nicht alle Leute mögen.</th>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">1</span><input type="radio" id="wpforms-28835-field_76_13_1" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][13]" value="1" aria-errormessage="wpforms-28835-field_76_13_1-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_13_1"><span
class="wpforms-screen-reader-element">Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 1</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">2</span><input type="radio" id="wpforms-28835-field_76_13_2" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][13]" value="2" aria-errormessage="wpforms-28835-field_76_13_2-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_13_2"><span
class="wpforms-screen-reader-element">Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 2</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">3</span><input type="radio" id="wpforms-28835-field_76_13_3" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][13]" value="3" aria-errormessage="wpforms-28835-field_76_13_3-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_13_3"><span
class="wpforms-screen-reader-element">Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 3</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">4</span><input type="radio" id="wpforms-28835-field_76_13_4" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][13]" value="4" aria-errormessage="wpforms-28835-field_76_13_4-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_13_4"><span
class="wpforms-screen-reader-element">Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 4</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">5</span><input type="radio" id="wpforms-28835-field_76_13_5" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][13]" value="5" aria-errormessage="wpforms-28835-field_76_13_5-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_13_5"><span
class="wpforms-screen-reader-element">Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 5</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">6</span><input type="radio" id="wpforms-28835-field_76_13_6" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][13]" value="6" aria-errormessage="wpforms-28835-field_76_13_6-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_13_6"><span
class="wpforms-screen-reader-element">Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 6</span></label></div>
</td>
<td>
<div class="wpforms-likert-scale-mobile-flex"><span class="wpforms-likert-scale-mobile-label">7</span><input type="radio" id="wpforms-28835-field_76_13_7" class="wpforms-screen-reader-element wpforms-likert-scale-option"
name="wpforms[fields][76][13]" value="7" aria-errormessage="wpforms-28835-field_76_13_7-error" aria-describedby="wpforms-28835-field_76-description"><label for="wpforms-28835-field_76_13_7"><span
class="wpforms-screen-reader-element">Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 7</span></label></div>
</td>
</tr>
</tbody>
</table>
<div id="wpforms-28835-field_76-description" class="wpforms-field-description">1= trifft überhaupt nicht zu 7= trifft voll und ganz zu</div>
</fieldset>
</div>
<div id="wpforms-28835-field_15-container" class="wpforms-field wpforms-field-pagebreak" data-field-id="15"></div>
</div>
</div><!-- .wpforms-field-container -->
<div class="wpforms-submit-container" style="display:none;"><input type="hidden" name="wpforms[id]" value="28835"><input type="hidden" name="page_title" value="Onboarding"><input type="hidden" name="page_url"
value="https://espace-coaching.ch/"><input type="hidden" name="page_id" value="28859"><input type="hidden" name="wpforms[post_id]" value="28859"><button type="submit" name="wpforms[submit]" id="wpforms-submit-28835" class="wpforms-submit"
data-alt-text="Senden…" data-submit-text="Absenden" aria-live="assertive" value="wpforms-submit">Absenden</button><img decoding="async" src="https://espace-coaching.ch/wp-content/plugins/wpforms/assets/images/submit-spin.svg"
class="wpforms-submit-spinner" style="display: none;" width="26" height="26" alt="Wird geladen"><a href="#" class="wpforms-save-resume-button"><span>Speichern und später fortsetzen</span></a></div>
</form>POST /
<form class="wpforms-validate wpforms-form wpforms-save-resume-email-notification" method="post" action="/" data-token="0adfeb9558ef1d67963a128ebc657986" novalidate="novalidate">
<div class="wpforms-field wpforms-field-email">
<label class="wpforms-field-label wpforms-save-resume-label"> E-Mail <span class="wpforms-required-label">*</span>
</label>
<input type="email" name="wpforms[save_resume_email]" required="">
</div>
<div class="wpforms-submit-container">
<input type="hidden" id="_wpnonce" name="_wpnonce" value="5ef9e70e82"><input type="hidden" name="_wp_http_referer" value="/"> <input type="hidden" name="wpforms[form_id]" value="28835">
<input type="hidden" name="wpforms[entry_id]" class="wpforms-save-resume-entry-id" value="">
<button type="submit" name="wpforms[save-resume]" class="wpforms-submit" value="wpforms-submit" disabled=""> Link senden </button>
</div>
</form>Text Content
Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen. Bitte aktiviere JavaScript in deinem Browser, um dieses Formular fertigzustellen. - Schritt 1 von 4 Damit wir möglichst bald mit dem Coaching starten können, brauche ich zuerst Informationen zu Ihrem aktuellen Gesundheitszustand und Lebensstil. Bitte füllen Sie diesen Fragebogen bis 24 Stunden vor dem Erstgespräch aus. Das Formular kann in mehreren Sessions ausgefüllt werden, die von Ihnen eingegeben Daten werden dann auf den Servern der espace Health Gesundheitszentren AG zwischengespeichert. Scrollen Sie bis ans Ende des Formulars, um Ihre Angaben zwischenzuspeichern. Mit diesen Antworten können wir speditiv gemeinsam ins Coaching starten. Herzlichen Dank für's zeitgerechte Ausfüllen, ich freue mich sehr auf Sie! PERSONENDATEN Wie lautet Ihr Vor- und Nachname? * Bitte geben Sie Ihre Telefonnummer an * United States +1 * United States+1 * United Kingdom+44 * * Afghanistan+93 * Albania+355 * Algeria+213 * American Samoa+1 * Andorra+376 * Angola+244 * Anguilla+1 * Antigua & Barbuda+1 * Argentina+54 * Armenia+374 * Aruba+297 * Ascension Island+247 * Australia+61 * Austria+43 * Azerbaijan+994 * Bahamas+1 * Bahrain+973 * Bangladesh+880 * Barbados+1 * Belarus+375 * Belgium+32 * Belize+501 * Benin+229 * Bermuda+1 * Bhutan+975 * Bolivia+591 * Bosnia & Herzegovina+387 * Botswana+267 * Brazil+55 * British Indian Ocean Territory+246 * British Virgin Islands+1 * Brunei+673 * Bulgaria+359 * Burkina Faso+226 * Burundi+257 * Cambodia+855 * Cameroon+237 * Canada+1 * Cape Verde+238 * Caribbean Netherlands+599 * Cayman Islands+1 * Central African Republic+236 * Chad+235 * Chile+56 * China+86 * Christmas Island+61 * Cocos (Keeling) Islands+61 * Colombia+57 * Comoros+269 * Congo - Brazzaville+242 * Congo - Kinshasa+243 * Cook Islands+682 * Costa Rica+506 * Croatia+385 * Cuba+53 * Curaçao+599 * Cyprus+357 * Czechia+420 * Côte d’Ivoire+225 * Denmark+45 * Djibouti+253 * Dominica+1 * Dominican Republic+1 * Ecuador+593 * Egypt+20 * El Salvador+503 * Equatorial Guinea+240 * Eritrea+291 * Estonia+372 * Eswatini+268 * Ethiopia+251 * Falkland Islands+500 * Faroe Islands+298 * Fiji+679 * Finland+358 * France+33 * French Guiana+594 * French Polynesia+689 * Gabon+241 * Gambia+220 * Georgia+995 * Germany+49 * Ghana+233 * Gibraltar+350 * Greece+30 * Greenland+299 * Grenada+1 * Guadeloupe+590 * Guam+1 * Guatemala+502 * Guernsey+44 * Guinea+224 * Guinea-Bissau+245 * Guyana+592 * Haiti+509 * Honduras+504 * Hong Kong SAR China+852 * Hungary+36 * Iceland+354 * India+91 * Indonesia+62 * Iran+98 * Iraq+964 * Ireland+353 * Isle of Man+44 * Israel+972 * Italy+39 * Jamaica+1 * Japan+81 * Jersey+44 * Jordan+962 * Kazakhstan+7 * Kenya+254 * Kiribati+686 * Kosovo+383 * Kuwait+965 * Kyrgyzstan+996 * Laos+856 * Latvia+371 * Lebanon+961 * Lesotho+266 * Liberia+231 * Libya+218 * Liechtenstein+423 * Lithuania+370 * Luxembourg+352 * Macao SAR China+853 * Madagascar+261 * Malawi+265 * Malaysia+60 * Maldives+960 * Mali+223 * Malta+356 * Marshall Islands+692 * Martinique+596 * Mauritania+222 * Mauritius+230 * Mayotte+262 * Mexico+52 * Micronesia+691 * Moldova+373 * Monaco+377 * Mongolia+976 * Montenegro+382 * Montserrat+1 * Morocco+212 * Mozambique+258 * Myanmar (Burma)+95 * Namibia+264 * Nauru+674 * Nepal+977 * Netherlands+31 * New Caledonia+687 * New Zealand+64 * Nicaragua+505 * Niger+227 * Nigeria+234 * Niue+683 * Norfolk Island+672 * North Korea+850 * North Macedonia+389 * Northern Mariana Islands+1 * Norway+47 * Oman+968 * Pakistan+92 * Palau+680 * Palestinian Territories+970 * Panama+507 * Papua New Guinea+675 * Paraguay+595 * Peru+51 * Philippines+63 * Poland+48 * Portugal+351 * Puerto Rico+1 * Qatar+974 * Romania+40 * Russia+7 * Rwanda+250 * Réunion+262 * Samoa+685 * San Marino+378 * Saudi Arabia+966 * Senegal+221 * Serbia+381 * Seychelles+248 * Sierra Leone+232 * Singapore+65 * Sint Maarten+1 * Slovakia+421 * Slovenia+386 * Solomon Islands+677 * Somalia+252 * South Africa+27 * South Korea+82 * South Sudan+211 * Spain+34 * Sri Lanka+94 * St. Barthélemy+590 * St. Helena+290 * St. Kitts & Nevis+1 * St. Lucia+1 * St. Martin+590 * St. Pierre & Miquelon+508 * St. Vincent & Grenadines+1 * Sudan+249 * Suriname+597 * Svalbard & Jan Mayen+47 * Sweden+46 * Switzerland+41 * Syria+963 * São Tomé & Príncipe+239 * Taiwan+886 * Tajikistan+992 * Tanzania+255 * Thailand+66 * Timor-Leste+670 * Togo+228 * Tokelau+690 * Tonga+676 * Trinidad & Tobago+1 * Tunisia+216 * Turkey+90 * Turkmenistan+993 * Turks & Caicos Islands+1 * Tuvalu+688 * U.S. Virgin Islands+1 * Uganda+256 * Ukraine+380 * United Arab Emirates+971 * United Kingdom+44 * United States+1 * Uruguay+598 * Uzbekistan+998 * Vanuatu+678 * Vatican City+39 * Venezuela+58 * Vietnam+84 * Wallis & Futuna+681 * Western Sahara+212 * Yemen+967 * Zambia+260 * Zimbabwe+263 * Åland Islands+358 Diese Nummer wird als Kontaktnummer verwendet. Was ist Ihre berufliche Tätigkeit? * revDSG Einverständnis * * Ich willige ein, dass diese Website meine übermittelten Informationen speichert, sodass meine Anfrage beantwortet werden kann. IHRE MOTIVATION ein cm) im Beschreiben Sie den Hauptgrund, weshalb Sie sich für ein persönliches Gesundheitscoaching entschieden haben. * Was sind Ihre Ziele für das Gesundheitscoaching? * * Mental besser fühlen * Stress regulieren * Besser schlafen * Körperliche Beschwerden reduzieren * Körperlich aktiver sein * Gesünder ernähren * Sonstiges Falls Sie körperliche Beschwerden reduzieren möchten: um welche handelt es sich? * WeiterSpeichern und später fortsetzen ANAMNESE Ihre Grösse (in cm) * Ihr Gewicht (in kg) * Wurden bei Ihnen Krankheiten diagnostiziert? * * Ja * Nein * Die Hausarztpraxis Huttwil verfügt über alle Informationen zu meinen Krankheiten. Befinden Sie sich derzeit in ärztlicher oder therapeutischer Behandlung? * * Ja * Nein Bei welchen Gesundheitsfachpersonen befinden Sie sich in ärztlicher oder therapeutischer Behandlung? (Hausarztpraxis / Physiotherapie / Ernährungsberatung / Naturheilpraktik / Neuraltherapie / Psychotherapie u.s.w.) * Hatten Sie kürzlich eine Operation? * * Ja * Nein Was für eine Operation hatten Sie kürzlich? * Leiden Sie unter Allergien? * * Ja * Nein Welche Allergien haben Sie? * Rauchen Sie? * * Ja * Nein Wie viele Zigaretten rauchen Sie pro Tag? * Sind Sie schwanger oder haben Sie in den letzten 6 Monaten geboren? * * Ja * Nein Hat Ihnen ein Arzt jemals gesagt, dass Sie ein Herzleiden ODER einen hohen Blutdruck haben? * * Ja * Nein Verlieren Sie Ihr Gleichgewicht aufgrund von Schwindelgefühlen ODER haben Sie in den letzten 12 Monaten das Bewusstsein verloren? * * Ja * Nein Nehmen Sie derzeit Medikamente ein (auch nicht-rezeptpflichtige)? * * Ja * Nein Welche Medikamente oder Produkte nehmen Sie ein? * Wie würden Sie Ihr aktuelles Fitnesslevel bezeichnen von 1-10? * 12345678910 1Fitnesslevel 1 2Fitnesslevel 2 3Fitnesslevel 3 4Fitnesslevel 4 5Fitnesslevel 5 6Fitnesslevel 6 7Fitnesslevel 7 8Fitnesslevel 8 9Fitnesslevel 9 10Fitnesslevel 10 ZurückWeiterSpeichern und später fortsetzen LEBENSSTIL Wieviel Stunden sitzen oder liegen Sie täglich (ohne Schlafenszeit)? * Während der Arbeit, beim Essen, auf dem Sofa liegend etc. Für wie viele Minuten pro Woche bewegen Sie sich mit mittlerer Intensität? * (Mittlere Intensität = Sie beginnen verstärkt zu atmen und Ihr Puls ist erhöht. Sie könnten bei der Aktivität noch sprechen. -> Zum Beispiel zügiges zu Fuss gehen, Velofahren, Gartenarbeiten) Für wie viele Minuten pro Woche bewegen Sie sich mit hoher Intensität? (Hohe Intensität = Ihr Puls ist stark erhöht, Sie atmen mit hoher Frequenz. Während der Aktivität sind nur noch kurze Wortwechsel möglich. -> Zum Beispiel Jogging, Krafttraining an Fitnessgeräten, Liegestützen) Treiben Sie Sport? * * Ja * Nein Welchen Sport betreiben Sie? * Wie oft betreiben Sie Krafttraining, welches alle grossen Muskelgruppen (Beine, Hüfte, Rücken, Bauch, Brust, Schultern und Arme) trainiert? * * Nie * Ca. 1-mal im Monat * Ca. 2-mal im Monat * Ca. 1-mal pro Woche * Ca. 2-mal pro Woche * Ca. 3-mal oder mehr pro Woche Wo sind Sie am liebsten körperlich aktiv? * * Draussen * Drinnen * Beides * Spielt mir keine Rolle In welcher sozialen Form betätigen Sie sich körperlich am liebsten? * * Alleine * In der Gruppe * Mit einer nahestehenden Person * Weiss nicht * Spielt mir keine Rolle Falls Sie gerne aktiver wären. Was sind die Gründe, wieso Sie eventuell noch nicht so weit sind? Wie oft essen Sie im Alltag auswärts z.B. im Restaurant oder der Kantine? * * Täglich * Mehrmals pro Woche * Ca. 1-mal pro Woche * Ca. 2-3 mal pro Monat * Sehr selten * Nie Wie essen Sie normalerweise zuhause? * * Mit einer oder mehreren anderen erwachsenen Personen * Mit einem oder mehreren Kindern * Alleine * Sonstiges Wer kocht bei Ihnen zuhause? * * Ich * Ich, gemeinsam oder abwechselnd mit anderen Personen * Jemand anderes * Sonstiges Wie oft essen Sie folgende Produkte * NieSeltener als 1-mal pro WocheCa. 1-mal pro WocheMehrmals pro WocheTäglichMehrmals täglich Früchte (Fruchtsäfte zählen nicht) NieFrüchte (Fruchtsäfte zählen nicht) Nie Seltener als 1-mal pro WocheFrüchte (Fruchtsäfte zählen nicht) Seltener als 1-mal pro Woche Ca. 1-mal pro WocheFrüchte (Fruchtsäfte zählen nicht) Ca. 1-mal pro Woche Mehrmals pro WocheFrüchte (Fruchtsäfte zählen nicht) Mehrmals pro Woche TäglichFrüchte (Fruchtsäfte zählen nicht) Täglich Mehrmals täglichFrüchte (Fruchtsäfte zählen nicht) Mehrmals täglich Ungesalzene Nüsse oder Samen NieUngesalzene Nüsse oder Samen Nie Seltener als 1-mal pro WocheUngesalzene Nüsse oder Samen Seltener als 1-mal pro Woche Ca. 1-mal pro WocheUngesalzene Nüsse oder Samen Ca. 1-mal pro Woche Mehrmals pro WocheUngesalzene Nüsse oder Samen Mehrmals pro Woche TäglichUngesalzene Nüsse oder Samen Täglich Mehrmals täglichUngesalzene Nüsse oder Samen Mehrmals täglich Gemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* NieGemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Nie Seltener als 1-mal pro WocheGemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Seltener als 1-mal pro Woche Ca. 1-mal pro WocheGemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Ca. 1-mal pro Woche Mehrmals pro WocheGemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Mehrmals pro Woche TäglichGemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Täglich Mehrmals täglichGemüse wie zum Beispiel Brokkoli, Gurken oder Ähnliches?* Mehrmals täglich Hülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) NieHülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Nie Seltener als 1-mal pro WocheHülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Seltener als 1-mal pro Woche Ca. 1-mal pro WocheHülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Ca. 1-mal pro Woche Mehrmals pro WocheHülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Mehrmals pro Woche TäglichHülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Täglich Mehrmals täglichHülsenfrüchte (z.B. Bohnen, Erbsen, Linsen, etc.) Mehrmals täglich Fleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) NieFleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Nie Seltener als 1-mal pro WocheFleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Seltener als 1-mal pro Woche Ca. 1-mal pro WocheFleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Ca. 1-mal pro Woche Mehrmals pro WocheFleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Mehrmals pro Woche TäglichFleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Täglich Mehrmals täglichFleischprodukte (Aufschnitt, Wurst, Pastete, Hamburger, etc.) Mehrmals täglich *Stärkehaltige Gemüse wie Kartoffeln, Mais oder Gemüsesaft zählen nicht Wie oft essen Sie Vollkornprodukte anstelle von anderen Getreideprodukten? * * Nie * Ab und zu * Oft * Fast immer Wie oft essen Sie, um andere Bedürfnisse als Ihren Hunger zu stillen, zum Beispiel aus Langeweile, Stress oder Einsamkeit? * * Nie * Selten * Manchmal * Oft * Sehr oft Wieviel Wasser und/oder ungesüssten Tee trinken Sie pro Tag? (Angabe in Liter) * Wie oft trinken Sie zusätzlich folgende Getränke * NieSeltener als 1-mal pro WocheCa. 1-mal pro WocheMehrmals pro WocheTäglich Gesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. NieGesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Nie Seltener als 1-mal pro WocheGesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Seltener als 1-mal pro Woche Ca. 1-mal pro WocheGesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Ca. 1-mal pro Woche Mehrmals pro WocheGesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Mehrmals pro Woche TäglichGesüsste Getränke wie Limonaden, Sportgetränke, Energydrinks etc. Täglich Alkoholische Getränke NieAlkoholische Getränke Nie Seltener als 1-mal pro WocheAlkoholische Getränke Seltener als 1-mal pro Woche Ca. 1-mal pro WocheAlkoholische Getränke Ca. 1-mal pro Woche Mehrmals pro WocheAlkoholische Getränke Mehrmals pro Woche TäglichAlkoholische Getränke Täglich Wie gross schätzen Sie Ihr Wissen in Bezug auf eine gesunde Ernährung, Nährstoffbedarfe des Körpers und Inhaltstoffe von Speisen ein? * * Sehr kleines Wissen * Kleines Wissen * Mittelmässig * Grosses Wissen * Sehr grosses Wissen Verspüren Sie Hungerattacken oder Gelüste? * * Nie * Selten * Manchmal * Oft * Sehr oft Leiden Sie unter Verdauungsproblemen? * * Nie * Selten * Manchmal * Oft * Sehr oft Unter welchen Verdauungsproblemen leiden Sie? * * Gasbildung * Verstopfung * Durchfall * Magenschmerzen * Krämpfe * Übelkeit * Sonstiges Wie oft hatten Sie im letzten Monat das Gefühl, nicht in der Lage zu sein, die wichtigen Dinge in Ihrem Leben kontrollieren zu können? * * Nie * Fast nie * Manchmal * Ziemlich oft * Sehr oft Wie oft waren Sie im letzten Monat zuversichtlich, dass Sie fähig sind, ihre persönlichen Probleme zu bewältigen? * * Nie * Fast nie * Manchmal * Ziemlich oft * Sehr oft Wie oft hatten Sie im letzten Monat das Gefühl, dass sich die Dinge zu Ihren Gunsten entwickeln? * * Nie * Fast nie * Manchmal * Ziemlich oft * Sehr oft Wie oft hatten Sie im letzten Monat das Gefühl, dass sich so viele Schwierigkeiten angehäuft haben, dass Sie diese nicht überwinden konnten? * * Nie * Fast nie * Manchmal * Ziemlich oft * Sehr oft Wie oft haben Sie sich im letzten Monat nervös und "gestresst" gefühlt? * * Nie * Fast nie * Manchmal * Ziemlich oft * Sehr oft Fühlen Sie sich öfters einsam? * * Nie * Fast nie * Manchmal * Ziemlich oft * Sehr oft Wie schätzen Sie Ihre aktuelle Produktivität in Bezug auf berufliche Herausforderungen auf einer Skala von 1-10 ein? * 12345678910 1Fitnesslevel 1 2Fitnesslevel 2 3Fitnesslevel 3 4Fitnesslevel 4 5Fitnesslevel 5 6Fitnesslevel 6 7Fitnesslevel 7 8Fitnesslevel 8 9Fitnesslevel 9 10Fitnesslevel 10 Wann sind Sie im letzten Monat normalerweise zu Bett gegangen? * * Vor 21:00 Uhr * Zwischen 21:00 und 23:00 Uhr * Zwischen 23:00 und 01:00 Uhr * Zwischen 01:00 und 02:00 Uhr * Nach 02:00 Uhr * Verschieden / Ich arbeite Schichtarbeit Wann sind Sie im letzten Monat normalerweise aufgestanden? * * Vor 05:00 Uhr * Zwischen 05:00 und 06:00 Uhr * Zwischen 06:00 und 07:00 Uhr * Zwischen 07:00 und 08:00 Uhr * Zwischen 08:00 und 09:00 Uhr * Nach 09:00 Uhr Wie lange hat es Sie im letzten Monat im normalerweise gedauert, bis Sie nach dem zu Bett gehen eingeschlafen sind? * * Weniger als 5 Minuten * 5-15 Minuten * 16-30 Minuten * 31-60 Minuten * Mehr als 1 Stunde Im letzten Monat, wie viele Stunden haben Sie im Durchschnitt effektiv geschlafen pro Nacht? * * 2-3 * 4-5 * 6-7 * 8-9 * 10-12 * Mehr als 12 Im letzten Monat, wie oft wurde Ihr Schlaf dadurch gestört, dass Sie mitten in der Nacht oder frühmorgens vor dem Wecker aufgewacht sind? * * Nie * Selten * Manchmal * Oft * Sehr oft Wie würden Sie Ihre allgemeine Schlafqualität im letzten Monat bewerten (1= sehr schlecht, 10 = hervorragend) * 12345678910 1Fitnesslevel 1 2Fitnesslevel 2 3Fitnesslevel 3 4Fitnesslevel 4 5Fitnesslevel 5 6Fitnesslevel 6 7Fitnesslevel 7 8Fitnesslevel 8 9Fitnesslevel 9 10Fitnesslevel 10 Wie stark ist Ihre Leistungsfähigkeit tagsüber durch einen schlechten Schlaf beeinträchtigt? * * Gar nicht * Ein wenig * Mal so mal so * Ziemlich * Sehr stark ZurückWeiterSpeichern und später fortsetzen SCHLUSSSPURT Bald haben Sie es geschafft! gestört, schätzen hervorragend) Beantworten Sie die letzten Fragen bitte auf einer Skala von 1-7. 1234567 Wenn ich Pläne habe, verfolge ich Sie auch. 1Wenn ich Pläne habe, verfolge ich Sie auch. 1 2Wenn ich Pläne habe, verfolge ich Sie auch. 2 3Wenn ich Pläne habe, verfolge ich Sie auch. 3 4Wenn ich Pläne habe, verfolge ich Sie auch. 4 5Wenn ich Pläne habe, verfolge ich Sie auch. 5 6Wenn ich Pläne habe, verfolge ich Sie auch. 6 7Wenn ich Pläne habe, verfolge ich Sie auch. 7 Normalerweise schaffe ich alles irgendwie. 1Normalerweise schaffe ich alles irgendwie. 1 2Normalerweise schaffe ich alles irgendwie. 2 3Normalerweise schaffe ich alles irgendwie. 3 4Normalerweise schaffe ich alles irgendwie. 4 5Normalerweise schaffe ich alles irgendwie. 5 6Normalerweise schaffe ich alles irgendwie. 6 7Normalerweise schaffe ich alles irgendwie. 7 Ich lasse mich nicht so schnell aus der Bahn werfen. 1Ich lasse mich nicht so schnell aus der Bahn werfen. 1 2Ich lasse mich nicht so schnell aus der Bahn werfen. 2 3Ich lasse mich nicht so schnell aus der Bahn werfen. 3 4Ich lasse mich nicht so schnell aus der Bahn werfen. 4 5Ich lasse mich nicht so schnell aus der Bahn werfen. 5 6Ich lasse mich nicht so schnell aus der Bahn werfen. 6 7Ich lasse mich nicht so schnell aus der Bahn werfen. 7 Ich mag mich. 1Ich mag mich. 1 2Ich mag mich. 2 3Ich mag mich. 3 4Ich mag mich. 4 5Ich mag mich. 5 6Ich mag mich. 6 7Ich mag mich. 7 Ich kann mehrere Dinge gleichzeitig bewältigen. 1Ich kann mehrere Dinge gleichzeitig bewältigen. 1 2Ich kann mehrere Dinge gleichzeitig bewältigen. 2 3Ich kann mehrere Dinge gleichzeitig bewältigen. 3 4Ich kann mehrere Dinge gleichzeitig bewältigen. 4 5Ich kann mehrere Dinge gleichzeitig bewältigen. 5 6Ich kann mehrere Dinge gleichzeitig bewältigen. 6 7Ich kann mehrere Dinge gleichzeitig bewältigen. 7 Ich bin entschlossen. 1Ich bin entschlossen. 1 2Ich bin entschlossen. 2 3Ich bin entschlossen. 3 4Ich bin entschlossen. 4 5Ich bin entschlossen. 5 6Ich bin entschlossen. 6 7Ich bin entschlossen. 7 Ich nehme die Dinge wie sie kommen. 1Ich nehme die Dinge wie sie kommen. 1 2Ich nehme die Dinge wie sie kommen. 2 3Ich nehme die Dinge wie sie kommen. 3 4Ich nehme die Dinge wie sie kommen. 4 5Ich nehme die Dinge wie sie kommen. 5 6Ich nehme die Dinge wie sie kommen. 6 7Ich nehme die Dinge wie sie kommen. 7 Ich behalte an vielen Dingen Interesse. 1Ich behalte an vielen Dingen Interesse. 1 2Ich behalte an vielen Dingen Interesse. 2 3Ich behalte an vielen Dingen Interesse. 3 4Ich behalte an vielen Dingen Interesse. 4 5Ich behalte an vielen Dingen Interesse. 5 6Ich behalte an vielen Dingen Interesse. 6 7Ich behalte an vielen Dingen Interesse. 7 Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 1Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 1 2Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 2 3Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 3 4Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 4 5Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 5 6Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 6 7Normalerweise kann ich eine Situation aus mehreren Perspektiven bet rachten. 7 Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 1Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 1 2Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 2 3Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 3 4Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 4 5Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 5 6Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 6 7Ich kann mich auch überwinden, Dinge zu tun, die ich eigentlich nicht machen will. 7 Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 1Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 1 2Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 2 3Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 3 4Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 4 5Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 5 6Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 6 7Wenn ich in einer schwierigen Situation bin, finde ich gewöhnlich eine n Weg heraus. 7 In mir steckt genügend Energie, um alles zu machen was ich machen muss. 1In mir steckt genügend Energie, um alles zu machen was ich machen muss. 1 2In mir steckt genügend Energie, um alles zu machen was ich machen muss. 2 3In mir steckt genügend Energie, um alles zu machen was ich machen muss. 3 4In mir steckt genügend Energie, um alles zu machen was ich machen muss. 4 5In mir steckt genügend Energie, um alles zu machen was ich machen muss. 5 6In mir steckt genügend Energie, um alles zu machen was ich machen muss. 6 7In mir steckt genügend Energie, um alles zu machen was ich machen muss. 7 Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 1Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 1 2Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 2 3Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 3 4Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 4 5Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 5 6Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 6 7Ich kann es akzeptieren, wenn mich nicht alle Leute mögen. 7 1= trifft überhaupt nicht zu 7= trifft voll und ganz zu AbsendenSpeichern und später fortsetzen Wenn Sie ihren Fortschritt jetzt speichern, wird eine Kopie Ihres Eintrags auf dem Server der espace health Gesundheitszentren AG abgelegt und ein Link für den Zugriff auf den Fragebogen generiert. Jede Person, mit der dieser Linkg geteilt wird, wird auf Ihre bisherigen Eingaben zugreifen können. Weiter Zurück Ihr Formulareintrag wurde gespeichert und es wurde ein eindeutiger Link erstellt, auf den Sie zugreifen können, um dieses Formular fortzusetzen. Geben Sie Ihre E-Mail-Adresse ein, um den Link per E-Mail zu erhalten. Alternativ könnenSie den Link unten kopieren und speichern. Bitte beachten Sie, dass dieser Link nicht weitergegeben werden sollte und dass er in 30 Tagen abläuft. Danach wird dein Formulareintrag gelöscht. Link kopieren E-Mail * Link senden Kontakt espace Gesundheitszentren AG Janine Schmutz Bahnhofstrasse 33 4950 Huttwil Links Hausarztpraxis Huttwil Datenschutz