{"id":2229,"date":"2019-03-26T11:26:17","date_gmt":"2019-03-26T10:26:17","guid":{"rendered":"https:\/\/vanlentsystems.com\/bestelformulier\/"},"modified":"2025-02-17T19:38:54","modified_gmt":"2025-02-17T18:38:54","slug":"order-form","status":"publish","type":"page","link":"https:\/\/vanlentsystems.com\/en\/pain-relief\/consumables\/order-form\/","title":{"rendered":"TENS Consumables Order Form"},"content":{"rendered":"<section class=\"l-section wpb_row height_medium\"><div class=\"l-section-h i-cf\"><div class=\"g-cols vc_row type_default valign_top\"><div class=\"vc_col-sm-12 wpb_column vc_column_container\"><div class=\"vc_column-inner\"><div class=\"wpb_wrapper\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3156-o1\" lang=\"nl-NL\" dir=\"ltr\" data-wpcf7-id=\"3156\">\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\/2229#wpcf7-f3156-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contactformulier\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"3156\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"nl_NL\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3156-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<div class=\"g-cols vc_row type_default valign_top order-form-row\">\n\t<div class=\"vc_col-sm-12 wpb_column info-column\" style=\"padding-bottom: 24px\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h2>TENS Consumables Order Form\n\t\t\t<\/h2>\n\t\t<\/div>\n\t<\/div>\n\t<div class = \"vc_col-sm-12 wpb_column email-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h3>Your Device\n\t\t\t<\/h3>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-6 wpb_column select-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Device <span class=\"wpcf7-form-control-wrap\" data-name=\"device\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"device\"><option value=\"\">&#8212;Kies een optie&#8212;<\/option><option value=\"i-Pulz\">i-Pulz<\/option><option value=\"i-Pulz 2\">i-Pulz 2<\/option><option value=\"i-Pulz 3\">i-Pulz 3<\/option><option value=\"Other\">Other<\/option><\/select><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<p><script>\n jQuery(document).ready(function() {\n jQuery('.wpcf7-select').children()[0].text = '\u2014Select a device\u2014';\n jQuery('[data-name=\"rem-device\"]').parent().hide();\n });\n jQuery('.wpcf7-select').on('change', function () {\n var selectedValue = jQuery(this).val();\n if (selectedValue === \"Other\") {\n jQuery('[data-name=\"rem-device\"]').parent().show();\n } else {\n jQuery('[data-name=\"rem-device\"]').parent().hide();\n jQuery('.wpcf7-text').val('');\n }\n });\n <\/script>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"vc_col-sm-6 wpb_column select-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Other <span class=\"wpcf7-form-control-wrap\" data-name=\"rem-device\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Type of device\" value=\"\" type=\"text\" name=\"rem-device\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column info-column\" style=\"margin-top: 32px\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h3>Your Data\n\t\t\t<\/h3>\n\t\t<\/div>\n\t<\/div>\n\t<div class = \"vc_col-sm-6 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Initials or first name* <span class=\"wpcf7-form-control-wrap\" data-name=\"firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"firstname\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Initials or firstname\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span><\/label><br \/>\n<label>Suffix <span class=\"wpcf7-form-control-wrap\" data-name=\"suffix\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"suffix\" aria-invalid=\"false\" placeholder=\"Suffix\" value=\"\" type=\"text\" name=\"suffix\" \/><\/span><\/label><br \/>\n<label>Last name* <span class=\"wpcf7-form-control-wrap\" data-name=\"lastname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"lastname\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Lastname\" value=\"\" type=\"text\" name=\"lastname\" \/><\/span><\/label><br \/>\n<label>Street name* <span class=\"wpcf7-form-control-wrap\" data-name=\"streetname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"streetname\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Street name\" value=\"\" type=\"text\" name=\"streetname\" \/><\/span><\/label><br \/>\n<label>House number* <span class=\"wpcf7-form-control-wrap\" data-name=\"housenumber\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"housenumber\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"House number\" value=\"\" type=\"text\" name=\"housenumber\" \/><\/span><\/label><br \/>\n<label>Postal code* <span class=\"wpcf7-form-control-wrap\" data-name=\"postalcode\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"postalcode\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Postal code\" value=\"\" type=\"text\" name=\"postalcode\" \/><\/span><\/label><br \/>\n<label>City* <span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"city\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"City\" value=\"\" type=\"text\" name=\"city\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t\t<p>Required fields are marked with an *\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-6 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Company name <span class=\"wpcf7-form-control-wrap\" data-name=\"company\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" autocomplete=\"organization\" aria-invalid=\"false\" placeholder=\"Company name\" value=\"\" type=\"text\" name=\"company\" \/><\/span><\/label><br \/>\n<label>E-mail address* <span class=\"wpcf7-form-control-wrap\" data-name=\"email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"E-mail address\" value=\"\" type=\"email\" name=\"email\" \/><\/span><\/label><br \/>\n<label>Phone number* <span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" autocomplete=\"phone\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone number.\" value=\"\" type=\"tel\" name=\"tel\" \/><\/span><\/label><br \/>\n<label>Date of birth* <span class=\"wpcf7-form-control-wrap\" data-name=\"dob\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"dob\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Date of birth\" value=\"\" type=\"text\" name=\"dob\" \/><\/span><\/label><br \/>\n<label>Health insurer* <span class=\"wpcf7-form-control-wrap\" data-name=\"insurance\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"insurance\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Health insurer\" value=\"\" type=\"text\" name=\"insurance\" \/><\/span><\/label><!-- 2025-02-05 RVL: Not used anyway..<label>Social security (BSN) number [ n u m b e r  bsn autocomplete:bsn placeholder \"Social security number\"]<\/label> --><br \/>\n<label>Insurance policy number <span class=\"wpcf7-form-control-wrap\" data-name=\"polis\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" autocomplete=\"polis\" aria-invalid=\"false\" placeholder=\"Policy number\" value=\"\" type=\"number\" name=\"polis\" \/><\/span><\/label>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"g-cols vc_row type_default valign_top order-form-row\">\n\t<div class = \"vc_col-sm-12 wpb_column product-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h3>Indicate which accessories you want to order\n\t\t\t<\/h3>\n\t\t\t<p>Looking for photos or more information on our TENS-consumables? Click <a href=\"https:\/\/vanlentsystems.com\/en\/pain-relief\/consumables\/\" target=\"_blank\">here<\/a>.\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n <!-- RVL 2024-06-24 div class=\"vc_col-sm-12 wpb_column product-column\">\n      <div class=\"vc_column-inner\">\n          <label>Black silicone electrodes<\/label>\n          <div class=\"g-cols vc_row type_default valign_top\">\n              <div class=\"vc_col-sm-6 wpb_column\">\n                  <div class=\"vc_column-inner\">\n                      <div class=\"single-product\"> [ n u m b e r  SQ05 min:0 max:15]<label>SQ05 black electrodes 38x44.5 mm (per 4 pieces)<\/label><\/div>\n                  <\/div>\n              <\/div>\n          <\/div>\n      <\/div>\n      <\/div-->\n\t<div class=\"vc_col-sm-12 wpb_column product-column\" style=\"margin-top: 24px;\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Brown Adhesive Electrodes<\/label>\n\t\t\t<\/p>\n\t\t\t<p>These are the standard recommended electrodes.\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE04\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE04\" \/><\/span><label>DE-04, 3.2cm round<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE05\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE05\" \/><\/span><label>DE-05, 5x10 cm rectangular<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE11\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE11\" \/><\/span><label>DE-11, 5 cm round<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE13\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE13\" \/><\/span><label>DE-13, 4x6 cm oval<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE24\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE24\" \/><\/span><label>DE-24, 5x5 cm square<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE25\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE25\" \/><\/span><label>DE-25, 15x9.5cm butterfly (single item)<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n <!-- 2025-06-10 div class=\"single-product\">[ n u m b e r   D E 4 1   m i n : 0   m a x : 1 5 ]<label>DE-41, 4x4 cm vierkant<\/label><\/div -->\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<p style=\"margin-top: 8px;\">For multiple use. Each electrode set contains 4 electrodes unless stated otherwise.\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\" style=\"margin-top: 24px;\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>White Adhesive Electrodes<\/label>\n\t\t\t<\/p>\n\t\t\t<p>In case you have experienced any form of skin irritation from the brown electrodes, you can switch to the white electrodes which may serve as a more skin-friendly alternative. If skin irritation persists after switching to the white electrodes, please contact us so we can help you further.\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n <!-- 2025-07-04 div class=\"single-product\">[ n u m b e r   D E 4 2   m i n : 0   m a x : 1 5 ]<label>DE-42, 4x4 cm vierkant<\/label><\/div -->\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE43\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE43\" \/><\/span><label>DE-43, 4x6 cm oval<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE44\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE44\" \/><\/span><label>DE-44, 3.2 cm round<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE45\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE45\" \/><\/span><label>DE-45, 15x9.5 cm butterfly (single item)<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n <!-- div class=\"single-product\">[ n u m b e r   D E 4 6   m i n : 0   m a x : 1 5 ]<label>DE-46, 4x4 cm square<\/label><\/div -->\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE48\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE48\" \/><\/span><label>DE-48, 5 cm round<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE51\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE51\" \/><\/span><label>DE-51, 5x5 cm square<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"DE52\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"DE52\" \/><\/span><label>DE-52, 5x10 cm rectangular<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<p style=\"margin-top: 8px;\">For multiple use. Each electrode set contains 4 electrodes unless stated otherwise.\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\" style=\"margin-top: 24px;\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Rubber Electrodes<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"PRU050050\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"PRU050050\" \/><\/span><label>PRU-050050, 5 cm square<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"PRU050090\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"15\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"PRU050090\" \/><\/span><label>PRU-050090, 5x10 cm rectangular<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<p style=\"margin-top: 8px;\">For multiple use. Each electrode set contains 2 electrodes unless stated otherwise.\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\" style=\"margin-top: 24px;\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>TENS Cables <\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n <!-- RVL 2025-01-29 uit assortiment div class=\"single-product\"> [ n u m b e r  Kabeli-Pulz50cm min:0 max:0]<label style=\"padding-top: 0\">EKI050 Cable i-Pulz 50 cm <b style=\"color: red\"><br>(Temporarily unavailable)<\/b><\/label><\/div-->\n <!-- RVL 2025-01-29 uit assortiment div class=\"single-product\"> [ n u m b e r  Kabeli-Pulz120cm min:0 max:0]<label style=\"padding-top: 0\">EKI120 Cable i-Pulz 120 cm <b style=\"color: red\"><br>(Temporarily unavailable)<\/b><\/label><\/div-->\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz150cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz150cm\" \/><\/span><label>EKI150 Cable for i-Pulz, 150 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz250cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz250cm\" \/><\/span><label>EKI051 Cable for i-Pulz 2, 50 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz2120cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz2120cm\" \/><\/span><label>EKI121 Cable for i-Pulz 2, 120 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz2150cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz2150cm\" \/><\/span><label>EKI151 Cable for i-Pulz 2, 150 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Splitter\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Splitter\" \/><\/span><label>Splitter-cable for i-Pulz and i-Pulz 2 (per 4 packed)<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz350cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz350cm\" \/><\/span><label>EKI053 Cable i-Pulz 3, 50 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz3100cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz3100cm\" \/><\/span><label>EKI103 Cable i-Pulz 3, 100 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz3120cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz3120cm\" \/><\/span><label>EKI123 Cable i-Pulz 3, 120 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"Kabeli-Pulz3150cm\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"4\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"Kabeli-Pulz3150cm\" \/><\/span><label>EKI153 Cable i-Pulz 3, 150 cm<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<p style=\"margin-top: 8px;\">Unless stated otherwise, cables are sold individually. You cannot order more than 4 cables of each type.\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\" style=\"margin-top: 24px;\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Bandages<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n <!-- RVL 2024-03-11 div class=\"vc_col-sm-6 wpb_column\">\n               <div class=\"vc_column-inner\">\n                   <div class=\"single-product\"> [ n u m b e r  AH08 min:0 max:2]<label>AH08, keyhole plaster (per 100 packed)<\/label><\/div>\n               <\/div>\n               <\/div-->\n\t\t\t\t<div class=\"vc_col-sm-12 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"AH10\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"AH10\" \/><\/span><label>AH10 Mefix Plaster roll 10 cm x 10 meter, adhesive plaster<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column product-column\" style=\"margin-top: 24px;\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Other<\/label>\n\t\t\t<\/p>\n\t\t\t<div class=\"g-cols vc_row type_default valign_top\">\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"GEL01\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"GEL01\" \/><\/span><label>GEL01, Conductive gel 60 grams<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"GEL07\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"GEL07\" \/><\/span><label>GEL07 Tensive conductive adhesive gel 50 grams<br \/>\n<i>(Only when using PRU electrodes)<\/i><\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"vc_col-sm-6 wpb_column\">\n\t\t\t\t\t<div class=\"vc_column-inner\">\n <!-- 2023-10-23 RVL: Uit ons assortiment. -->\n <!-- div class=\"single-product\">[ n u m b e r  GEL03 min:0 max:2]<label>GEL03, Pre-tac adhesive fluid 15 ml<\/label><\/div -->\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"GEL08\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"GEL08\" \/><\/span><label>GEL08 Signa healing spray 250 ml<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"single-product\">\n\t\t\t\t\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"SKIN\"><input class=\"wpcf7-form-control wpcf7-number wpcf7-validates-as-number\" min=\"0\" max=\"2\" aria-invalid=\"false\" value=\"\" type=\"number\" name=\"SKIN\" \/><\/span><label>SKIN, tens clean cote (per 50 pieces)<\/label>\n\t\t\t\t\t\t\t<\/p>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div class=\"g-cols vc_row type_default valign_top order-form-row\">\n\t<div class = \"vc_col-sm-12 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<h3>Additional Remarks\n\t\t\t<\/h3>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"vc_col-sm-12 wpb_column info-column\">\n\t\t<div class=\"vc_column-inner\">\n\t\t\t<p><label>Remark <span class=\"wpcf7-form-control-wrap\" data-name=\"comments\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"comments\"><\/textarea><\/span><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"privacy-statement\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"privacy-statement\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I agree with the privacy statement and the terms and conditions.<\/span><\/label><\/span><\/span><\/span>\n\t\t\t<\/p>\n\t\t\t<div style=\"display: inline-block; width: 32px; height: 4px;\">\n\t\t\t<\/div>\n\t\t\t<p><button class=\"btn-purple btn-solid btn-200\" id=\"send-form\" type=\"submit\">Order<\/button><button class=\"btn-purple btn-solid btn-200\" id=\"send-form-fake\" disabled>Order<\/button>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div>\n<div style=\"display: inline-block; width: 32px; height: 12px;\">\n<\/div>\n<div id=\"blank-space-when-not-validating\" style=\"display: inline-block; width: 32px; height: 48px;\">\n<\/div>\n<div id=\"validating\" style=\"text-align: center; display: none;\">\n\t<h4>One moment, please...\n\t<\/h4>\n<\/div>\n<div id=\"success\" style=\"text-align: center; display: none;\">\n\t<h2>Thank you for your order!\n\t<\/h2>\n\t<p>You will receive an email for us with the details of your order.\n\t<\/p>\n<\/div>\n<p><script>\njQuery(function($) {\n function $statusEl() {\n \/\/ Prefer the form; fall back to the closest ancestor that carries data-status.\n const $f = $(\"form\").first();\n if ($f.length && ($f.attr(\"data-status\") || $f.data(\"status\") != null)) return $f;\n const $c = jQuery(\"#send-form\").closest(\"[data-status]\");\n return $c.length ? $c : $f; \/\/ worst case: the form may not have data-status\n }\n\n function readStatus() {\n const $el = $statusEl();\n if (!$el || !$el.length) return \"init\";\n \/\/ Prefer attribute; fall back to jQuery .data() if some code uses that\n return ( $el.attr(\"data-status\") || $el.data(\"status\") || \"init\" ).toString().trim();\n }\n\n \/\/ This function does not actually disable the button. Instead, it swaps it with\n \/\/ a fake disabled button. 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