{"id":4216,"date":"2021-11-15T14:05:50","date_gmt":"2021-11-15T13:05:50","guid":{"rendered":"https:\/\/www.kiez-hypnose.de\/registration-non-smoker\/"},"modified":"2023-06-02T13:51:24","modified_gmt":"2023-06-02T11:51:24","slug":"registration-non-smoker","status":"publish","type":"page","link":"https:\/\/www.kiez-hypnose.de\/en\/registration-non-smoker\/","title":{"rendered":"Registration non-smoker"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; da_disable_devices=&#8221;off|off|off&#8221; global_colors_info=&#8221;{}&#8221; da_is_popup=&#8221;off&#8221; da_exit_intent=&#8221;off&#8221; da_has_close=&#8221;on&#8221; da_alt_close=&#8221;off&#8221; da_dark_close=&#8221;off&#8221; da_not_modal=&#8221;on&#8221; da_is_singular=&#8221;off&#8221; da_with_loader=&#8221;off&#8221; da_has_shadow=&#8221;on&#8221;][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text admin_label=&#8221;Methoden Aufz\u00e4hlung&#8221; _builder_version=&#8221;4.16&#8243; text_font=&#8221;||||||||&#8221; header_font=&#8221;OpenSans-Light|300|||||||&#8221; header_font_size=&#8221;70px&#8221; header_line_height=&#8221;1.2em&#8221; header_2_font=&#8221;||||||||&#8221; header_2_line_height=&#8221;1.2em&#8221; module_alignment=&#8221;right&#8221; custom_margin=&#8221;5%||0px||false|false&#8221; text_font_size_tablet=&#8221;&#8221; text_font_size_phone=&#8221;15px&#8221; text_font_size_last_edited=&#8221;on|desktop&#8221; header_font_size_tablet=&#8221;40px&#8221; header_font_size_phone=&#8221;25px&#8221; header_font_size_last_edited=&#8221;on|phone&#8221; header_2_font_size_tablet=&#8221;&#8221; header_2_font_size_phone=&#8221;&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2 style=\"text-align: center;\">Registration form non-smoking hypnosis<\/h2>\n<p>[\/et_pb_text][et_pb_divider color=&#8221;#e95e27&#8243; divider_position=&#8221;center&#8221; divider_weight=&#8221;2px&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; width=&#8221;100px&#8221; module_alignment=&#8221;center&#8221; custom_margin=&#8221;0px||20px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][\/et_pb_divider][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; width=&#8221;60%&#8221; width_tablet=&#8221;100%&#8221; width_phone=&#8221;100%&#8221; width_last_edited=&#8221;on|tablet&#8221; module_alignment=&#8221;center&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p>Dear Client,<\/p>\n<p>Your hypnosis appointment is initially marked, but not yet bindingly booked. For the booking I need some important information from you.<\/p>\n<p>Your details, as well as the contents of the session, will of course be treated confidentially. Please fill in all fields and click on &#8220;send&#8221; at the end of the form. Please make sure that &#8220;The message was successfully submitted&#8221; is displayed in your browser window at the end. It is advisable to prewrite the longer texts in a word processing program and then copy them over so that the content is not lost in case of technical problems. If you have any problems with sending me the email, there is a Word document at the end of this page, which you can download and send to me by email.<\/p>\n<p><strong>If the information is too sensitive for you to submit online here, you can also print out the form and mail it to my office address or drop it off in person. The practice&#8217;s letterbox is located in the entrance area of the medical centre and is only accessible during the day.<\/strong><\/p>\n<p><strong>You will then receive a binding confirmation of your session by email. If you do not receive an email within two working days, please call me!<\/strong><\/p>\n<p>Feel free to take some time to fill it out, it&#8217;s part of your preparation!<\/p>\n<p>I am looking forward to your registration!<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_code _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; width=&#8221;60%&#8221; width_tablet=&#8221;100%&#8221; width_phone=&#8221;100%&#8221; width_last_edited=&#8221;on|tablet&#8221; module_alignment=&#8221;center&#8221; global_colors_info=&#8221;{}&#8221;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f8846-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"8846\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/4216#wpcf7-f8846-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"8846\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f8846-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"kh-form-modern\">\n\t<div class=\"kh-form-header\">\n\t\t<p><span class=\"kh-eyebrow\">Non-Smoking Hypnosis<\/span>\n\t\t<\/p>\n\t\t<h2>Medical History Form & Session Preparation\n\t\t<\/h2>\n\t\t<p>Please fill out the form completely. Your information helps to prepare the session in the best possible way.\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"kh-section\">\n\t\t<h3>Appointment & Contact Details\n\t\t<\/h3>\n\t\t<div class=\"kh-grid\">\n\t\t\t<div class=\"kh-field kh-col-2\">\n\t\t\t\t<p><label>Date & time of the appointments*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"datum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"datum\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>First name & Last name*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"name-123\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"name-123\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Email*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"email-201\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"email-201\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Phone Mobile*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel-298\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"tel-298\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Date of birth*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gebdatum\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"gebdatum\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Street, No.*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"strasse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"strasse\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Zip code & City*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"ort\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"ort\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field kh-col-2\">\n\t\t\t\t<p><label>If applicable Differing invoice address<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"rechnungsadresse\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"rechnungsadresse\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field kh-col-2\">\n\t\t\t\t<p><label>Occupation*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"beruf\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"beruf\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"kh-section\">\n\t\t<h3>General Information\n\t\t<\/h3>\n\t\t<div class=\"kh-check-grid\">\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Existing pregnancy*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-schwangerschaft\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-schwangerschaft\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-schwangerschaft\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>I have already experienced hypnosis*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-hypnose\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-hypnose\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-hypnose\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"kh-section\">\n\t\t<h3>Physical Illnesses\n\t\t<\/h3>\n\t\t<div class=\"kh-check-grid\">\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Diseases: Epilepsy*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-epilepsie\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-epilepsie\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-epilepsie\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Strong asthma*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-asthma\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-asthma\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-asthma\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Other seizure disorders*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-sonstige\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-sonstige\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-sonstige\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Persistent severe pain*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-schmerzen\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-schmerzen\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-schmerzen\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Significant circulatory problems*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-kreislauf\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-kreislauf\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-kreislauf\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Infectious diseases, e.g. hepatitis B\/C*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-hepatitis\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-hepatitis\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-hepatitis\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Heart diseases*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-here\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-here\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-here\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Problems with shoulders, arms or hands*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-arme\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-arme\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-arme\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Other serious physical illness*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-sonstige2\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-sonstige2\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-sonstige2\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Physical or mental disability*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-behinderung\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-behinderung\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-behinderung\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"kh-grid kh-mt\">\n\t\t\t<div class=\"kh-field kh-col-2\">\n\t\t\t\t<p><label>If yes, which<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"welche-behinderung\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"welche-behinderung\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"kh-section\">\n\t\t<h3>Mental Health & Treatments\n\t\t<\/h3>\n\t\t<div class=\"kh-check-grid\">\n\t\t\t<div class=\"kh-check-card kh-wide\">\n\t\t\t\t<p><span>In treatment with psychotherapists*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-psychotherapeuten\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-psychotherapeuten\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-psychotherapeuten\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-psychotherapeuten\" value=\"Previously in treatment\" \/><span class=\"wpcf7-list-item-label\">Previously in treatment<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card kh-wide\">\n\t\t\t\t<p><span>Under treatment by psychiatrist or neurologist*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-psychiater\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-psychiater\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-psychiater\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-psychiater\" value=\"Previously in treatment\" \/><span class=\"wpcf7-list-item-label\">Previously in treatment<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>I am currently taking antidepressants or neuroleptics*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-antidepressiva\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-antidepressiva\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-antidepressiva\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Severe mental illness \/ psychosis*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-psychose\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-psychose\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-psychose\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>ADD, ADHD or HKS*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-ads\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-ads\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-ads\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<div class=\"kh-grid kh-mt\">\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Diagnosis and period, if applicable<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"diagnose\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"diagnose\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Regular intake of the following medicines<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"medikamente\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"medikamente\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Fears or phobias, if not a reason for treatment<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"phobien\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"phobien\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Allergies<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"allergien\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"allergien\" \/><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"kh-section\">\n\t\t<h3>Addictions & Consumption\n\t\t<\/h3>\n\t\t<div class=\"kh-check-grid\">\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Dependence on medications*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-medikamentenmissbrauch\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-medikamentenmissbrauch\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-medikamentenmissbrauch\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Alcohol dependence*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-alkohol\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-alkohol\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-alkohol\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Drug addiction, except tobacco*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-drogen2\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-drogen2\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-drogen2\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card kh-wide\">\n\t\t\t\t<p><span>Cannabis use*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-cannabis\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-cannabis\" value=\"Never\" \/><span class=\"wpcf7-list-item-label\">Never<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-cannabis\" value=\"Rarely\" \/><span class=\"wpcf7-list-item-label\">Rarely<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-cannabis\" value=\"Occasionally\" \/><span class=\"wpcf7-list-item-label\">Occasionally<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-cannabis\" value=\"Frequently\" \/><span class=\"wpcf7-list-item-label\">Frequently<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-cannabis\" value=\"Daily\" \/><span class=\"wpcf7-list-item-label\">Daily<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card\">\n\t\t\t\t<p><span>Experience with psychoactive drugs, e.g. LSD*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-drogen3\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-drogen3\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-drogen3\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"kh-section\">\n\t\t<h3>Session Preparation\n\t\t<\/h3>\n\t\t<div class=\"kh-grid\">\n\t\t\t<div class=\"kh-field kh-col-2\">\n\t\t\t\t<p><label>Meeting preparation: main reason for meeting*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"grund\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"grund\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field kh-col-2\">\n\t\t\t\t<p><label>Please describe what is the most important change you want to achieve with non-smoking hypnosis. Describe this change as clearly and completely as possible.*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"veraenderung\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"veraenderung\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Cigarettes smoked per day, average*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"zigarettenanzahl\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"zigarettenanzahl\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field\">\n\t\t\t\t<p><label>Please list briefly and in bullet points typical situations in which you smoke, e.g. in the morning with coffee*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"zigarettensituation\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"zigarettensituation\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-field kh-col-2\">\n\t\t\t\t<p><label>Take a few minutes and think about the BENEFITS you will achieve in your life by becoming smoke-free. For example, how this change will affect your work, your personal life, your relationship. How do other people perceive you as a result? How does it make you feel? Please write down at least 7 benefits. It is a help to phrase these benefits POSITIVELY, so instead of \"I no longer have a need to smoke,\" \"I feel free.\"*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"vorteile\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"vorteile\"><\/textarea><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"kh-section\">\n\t\t<h3>Further Information\n\t\t<\/h3>\n\t\t<div class=\"kh-check-grid\">\n\t\t\t<div class=\"kh-check-card kh-wide\">\n\t\t\t\t<p><span>How did you find out about Kiez Hypnosis?*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-herkunft\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Recommendation\" \/><span class=\"wpcf7-list-item-label\">Recommendation<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Recommendation by AI\" \/><span class=\"wpcf7-list-item-label\">Recommendation by AI<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Google Search\" \/><span class=\"wpcf7-list-item-label\">Google Search<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Google Advertisment\" \/><span class=\"wpcf7-list-item-label\">Google Advertisment<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Seen at the medical centre\" \/><span class=\"wpcf7-list-item-label\">Seen at the medical centre<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"HypnoBox\" \/><span class=\"wpcf7-list-item-label\">HypnoBox<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Workshop\" \/><span class=\"wpcf7-list-item-label\">Workshop<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Norbert Preetz List of therapists\" \/><span class=\"wpcf7-list-item-label\">Norbert Preetz List of therapists<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Facebook\" \/><span class=\"wpcf7-list-item-label\">Facebook<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Business card\" \/><span class=\"wpcf7-list-item-label\">Business card<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Therapeutenfinder.com\" \/><span class=\"wpcf7-list-item-label\">Therapeutenfinder.com<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-herkunft\" value=\"Therapeuten.de\" \/><span class=\"wpcf7-list-item-label\">Therapeuten.de<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t\t<div class=\"kh-check-card kh-wide\">\n\t\t\t\t<p><span>What tea would you like to drink in the session?*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-tee\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required wpcf7-exclusive-checkbox\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-tee\" value=\"Herbs\" \/><span class=\"wpcf7-list-item-label\">Herbs<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-tee\" value=\"Rooibos\" \/><span class=\"wpcf7-list-item-label\">Rooibos<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-tee\" value=\"Fruits\" \/><span class=\"wpcf7-list-item-label\">Fruits<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-tee\" value=\"Lemongrass\" \/><span class=\"wpcf7-list-item-label\">Lemongrass<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-tee\" value=\"Chamomile\" \/><span class=\"wpcf7-list-item-label\">Chamomile<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-tee\" value=\"Nettle\" \/><span class=\"wpcf7-list-item-label\">Nettle<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"checkbox-tee\" value=\"Doesn&#039;t matter\" \/><span class=\"wpcf7-list-item-label\">Doesn&#039;t matter<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-tee\" value=\"Water only\" \/><span class=\"wpcf7-list-item-label\">Water only<\/span><\/label><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"kh-section kh-legal\">\n\t\t<h3>Consents\n\t\t<\/h3>\n\t\t<div class=\"kh-consent\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-agb\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"checkbox-agb[]\" value=\"I have read and agree to the General Terms and Conditions (GTC file below)\" \/><span class=\"wpcf7-list-item-label\">I have read and agree to the General Terms and Conditions (GTC file below)<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"kh-consent\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-frist\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"checkbox-frist[]\" value=\"I agree to the cancellation deadline of 48 hours before each appointment. Cancellation must be made in good time by telephone (030-91701944) or by email to info@kiez-hypnose.de.\" \/><span class=\"wpcf7-list-item-label\">I agree to the cancellation deadline of 48 hours before each appointment. Cancellation must be made in good time by telephone (030-91701944) or by email to info@kiez-hypnose.de.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"kh-consent\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-datenschutz\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first last\"><label><input type=\"checkbox\" name=\"checkbox-datenschutz[]\" value=\"Data protection consent: I have taken note of the data protection declaration. I consent to my details and data being collected and stored electronically in order to respond to my enquiry. I can revoke my consent for the future at any time by sending an e-mail to info@kiez-hypnose.de.\" \/><span class=\"wpcf7-list-item-label\">Data protection consent: I have taken note of the data protection declaration. I consent to my details and data being collected and stored electronically in order to respond to my enquiry. I can revoke my consent for the future at any time by sending an e-mail to info@kiez-hypnose.de.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"kh-submit-wrap\">\n\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/et_pb_code][et_pb_code _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<style><!-- [et_pb_line_break_holder] -->  span.wpcf7-list-item { <!-- [et_pb_line_break_holder] -->    display: block;<!-- [et_pb_line_break_holder] -->  margin-top: 10px;<!-- [et_pb_line_break_holder] -->  }<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->  input[type=email], input[type=number], input[type=text], textarea {<!-- [et_pb_line_break_holder] -->    padding: 5px 15px;<!-- [et_pb_line_break_holder] -->    width: 70%;<!-- [et_pb_line_break_holder] -->  margin-top:10px;<!-- [et_pb_line_break_holder] --> }<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><\/style>\n<p>[\/et_pb_code][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=&#8221;1_2,1_2&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; width=&#8221;48%&#8221; width_tablet=&#8221;60%&#8221; width_phone=&#8221;60%&#8221; width_last_edited=&#8221;on|desktop&#8221; module_alignment=&#8221;center&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<span style=\"font-size: 100px;\"><i class=\"fas fa-file-pdf\"><\/i> <\/span><\/p>\n<p><strong>AGB Kiez Hypnosis<\/strong><br \/>\nGeneral terms and conditions of business <\/p>\n<p><a href=\"https:\/\/www.kiez-hypnose.de\/wp-content\/uploads\/2021\/11\/Allgemeine-Geschaeftsbedingungen-Kiez-Hypnose.pdf\" target=\"_blank\" rel=\"noopener\">Download<\/a>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.21.0&#8243; _module_preset=&#8221;default&#8221; hover_enabled=&#8221;0&#8243; global_colors_info=&#8221;{}&#8221; sticky_enabled=&#8221;0&#8243;]<\/p>\n<p><span style=\"font-size: 100px;\"><i class=\"fas fa-file-word\"><\/i> <\/span><\/p>\n<p><strong>Registration form non-smokers<\/strong><br \/>Registration form.docx<br \/><a href=\"https:\/\/www.kiez-hypnose.de\/wp-content\/uploads\/2021\/11\/Anmeldeformular-Nichtraucher.docx\" target=\"_blank\" rel=\"noopener\">Download<\/a><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Registration form non-smoking hypnosisDear Client, Your hypnosis appointment is initially marked, but not yet bindingly booked. For the booking I need some important information from you. Your details, as well as the contents of the session, will of course be treated confidentially. Please fill in all fields and click on &#8220;send&#8221; at the end of [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-4216","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/www.kiez-hypnose.de\/en\/wp-json\/wp\/v2\/pages\/4216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.kiez-hypnose.de\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.kiez-hypnose.de\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.kiez-hypnose.de\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kiez-hypnose.de\/en\/wp-json\/wp\/v2\/comments?post=4216"}],"version-history":[{"count":0,"href":"https:\/\/www.kiez-hypnose.de\/en\/wp-json\/wp\/v2\/pages\/4216\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.kiez-hypnose.de\/en\/wp-json\/wp\/v2\/media?parent=4216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}