{"id":1962,"date":"2023-10-10T14:06:01","date_gmt":"2023-10-10T12:06:01","guid":{"rendered":"https:\/\/beautygainz.com\/intake-form\/"},"modified":"2026-07-30T14:45:19","modified_gmt":"2026-07-30T12:45:19","slug":"intake-form","status":"publish","type":"page","link":"https:\/\/beautygainz.com\/en\/intake-form\/","title":{"rendered":"Intake form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1962\" class=\"elementor elementor-1962 elementor-1882\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-7198d86 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"7198d86\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-1364d1f\" data-id=\"1364d1f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2dd1729 elementor-widget elementor-widget-heading\" data-id=\"2dd1729\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Intake form<\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-31598eb elementor-widget elementor-widget-heading\" data-id=\"31598eb\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Hair transplant \/ Forehead reduction<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e79dae7 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e79dae7\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-e9ca2c1\" data-id=\"e9ca2c1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-79c97c4 elementor-widget elementor-widget-heading\" data-id=\"79c97c4\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Get your personal free hair plan<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7062b81 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"7062b81\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<form class=\"elementor-form\" method=\"post\" name=\"Intake form\" aria-label=\"Intake form\" novalidate=\"\">\n\t\t\t<input type=\"hidden\" name=\"post_id\" value=\"1962\"\/>\n\t\t\t<input type=\"hidden\" name=\"form_id\" value=\"7062b81\"\/>\n\t\t\t<input type=\"hidden\" name=\"referer_title\" value=\"Intake form - BeautyGainz\" \/>\n\n\t\t\t\t\t\t\t<input type=\"hidden\" name=\"queried_id\" value=\"1962\"\/>\n\t\t\t\n\t\t\t<div class=\"elementor-form-fields-wrapper elementor-labels-\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_33bacc8 elementor-col-100\">\n\t\t\t\t\tFull Name\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-voornaam elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-voornaam\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tFirst Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[voornaam]\" id=\"form-field-voornaam\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"First Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-tussenvoegsel elementor-col-33\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-tussenvoegsel\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tMiddle Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[tussenvoegsel]\" id=\"form-field-tussenvoegsel\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Middle Name\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-achternaam elementor-col-33 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-achternaam\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tLast Name\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[achternaam]\" id=\"form-field-achternaam\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"Last Name\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_3dfbf72 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">Date of birth<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-date elementor-field-group elementor-column elementor-field-group-geboortedatum elementor-col-50\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-geboortedatum\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tDate of birth\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\n\t\t<input type=\"date\" name=\"form_fields[geboortedatum]\" id=\"form-field-geboortedatum\" class=\"elementor-field elementor-size-sm  elementor-field-textual elementor-date-field elementor-use-native\" placeholder=\"Date of birth\" pattern=\"[0-9]{4}-[0-9]{2}-[0-9]{2}\">\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-email elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-email\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tE-mail\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[email]\" id=\"form-field-email\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" placeholder=\"E-mail\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ca5005d elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">In which country do you live?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-land elementor-col-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-land\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tCountry\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[land]\" id=\"form-field-land\" class=\"elementor-field elementor-size-sm  elementor-field-textual\" required=\"required\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_eae5c32 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 35px;\">Questions and details<br\/>The more you fill in, the better we'll be able to help!<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8567da6 elementor-col-100\">\n\t\t\t\t\t<hr\/>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_66e71bc elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">What bothers you most about your current hairline?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-watstoort elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-watstoort\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWhat bothers\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[watstoort]\" id=\"form-field-watstoort\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"High forehead\">High forehead<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Receding temples\">Receding temples<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Asymmetry\">Asymmetry<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Thin hairline\">Thin hairline<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Other\">Other<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_11e44e9 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">Do you suffer from hair loss?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-haarverlies elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-haarverlies\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tHair loss\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[haarverlies]\" id=\"form-field-haarverlies\" rows=\"4\" placeholder=\"If yes, please share when it started, if it runs in the family and if you did any tests to find out the reason. Also share the condition if relevant (alopecia, etc.) \" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_82d8e34 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">When would you ideally like to have the treatment?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-wanneer elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-wanneer\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWhen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[wanneer]\" id=\"form-field-wanneer\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"As soon as possible\">As soon as possible<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Within 1\u20136 months\">Within 1\u20136 months<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Within 1 year\">Within 1 year<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"I&#039;m still exploring my options\">I&#039;m still exploring my options<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_be2c5a9 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">What is currently holding you back?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-wathoudttegen elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-wathoudttegen\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWat houdt tegen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[wathoudttegen]\" id=\"form-field-wathoudttegen\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Cost\">Cost<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Uncertainty about the results\">Uncertainty about the results<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Work \/ social environment\">Work \/ social environment<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"I still have questions\">I still have questions<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Other\">Other<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_acd89a0 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">Do you already have a budget in mind?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-budget elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-budget\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tBudget\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[budget]\" id=\"form-field-budget\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"Under \u20ac2,500\">Under \u20ac2,500<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"\u20ac2,500 \u2013 \u20ac4,000\">\u20ac2,500 \u2013 \u20ac4,000<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"\u20ac4,000 \u2013 \u20ac6,000\">\u20ac4,000 \u2013 \u20ac6,000<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"More than \u20ac6,000\">More than \u20ac6,000<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_6069a83 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">Why are you considering a hairline lowering procedure?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-waarom elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-waarom\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWhy\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[waarom]\" id=\"form-field-waarom\" rows=\"4\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_ef041b9 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">How familiar are you with hairline lowering?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-alverdiept elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-alverdiept\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tAl verdiept\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[alverdiept]\" id=\"form-field-alverdiept\" class=\"elementor-field-textual elementor-size-sm\">\n\t\t\t\t\t\t\t\t\t<option value=\"Yes, I&#039;ve done extensive research\">Yes, I&#039;ve done extensive research<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"I know a little about it\">I know a little about it<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"I&#039;m just starting to explore it\">I&#039;m just starting to explore it<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_84fb7b7 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">Are you interested in going to the clinic in the Netherlands or Turkey?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-kliniek elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-kliniek\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tClinic\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[kliniek]\" id=\"form-field-kliniek\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_3d09432 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">How would you prefer us to contact you?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-select elementor-field-group elementor-column elementor-field-group-contact elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-contact\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tContact\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field elementor-select-wrapper remove-before \">\n\t\t\t<div class=\"select-caret-down-wrapper\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"eicon-caret-down\"><\/i>\t\t\t<\/div>\n\t\t\t<select name=\"form_fields[contact]\" id=\"form-field-contact\" class=\"elementor-field-textual elementor-size-sm\" required=\"required\">\n\t\t\t\t\t\t\t\t\t<option value=\"WhatsApp\">WhatsApp<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Phone\">Phone<\/option>\n\t\t\t\t\t\t\t\t\t<option value=\"Email\">Email<\/option>\n\t\t\t\t\t\t\t<\/select>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_6bd213b elementor-col-100\">\n\t\t\t\t\t<div style=\"margin: 20px 0;\"><hr><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-recaptcha_v3 elementor-field-group elementor-column elementor-field-group-recaptcha elementor-col-100 recaptcha_v3-bottomright\">\n\t\t\t\t\t<div class=\"elementor-field\" id=\"form-field-recaptcha\"><div class=\"elementor-g-recaptcha\" data-sitekey=\"6LfxfHooAAAAALUVxp3CcJxyga7FVySRNDbaBz3g\" data-type=\"v3\" data-action=\"Form\" data-badge=\"bottomright\" data-size=\"invisible\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_8feab76 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-bottom: 5px;\">Please send pictures of your hair (front, the sides and back side)<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-upload elementor-field-group elementor-column elementor-field-group-fotos elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-fotos\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tPictures\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input type=\"file\" name=\"form_fields[fotos][]\" id=\"form-field-fotos\" class=\"elementor-field elementor-size-sm  elementor-upload-field\" required=\"required\" multiple=\"multiple\" data-maxsize=\"50\" data-maxsize-message=\"This file exceeds the maximum allowed size.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_08ea870 elementor-col-100\">\n\t\t\t\t\t<div style=\"margin-top: 15px;\">If you woke up tomorrow with your ideal hairline, how would that change your life?<\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-watzouveranderen elementor-col-100 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-watzouveranderen\" class=\"elementor-field-label elementor-screen-only\">\n\t\t\t\t\t\t\t\tWat zou veranderen\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  elementor-size-sm\" name=\"form_fields[watzouveranderen]\" id=\"form-field-watzouveranderen\" rows=\"4\" required=\"required\"><\/textarea>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-html elementor-field-group elementor-column elementor-field-group-field_b0ade2b elementor-col-100\">\n\t\t\t\t\t&nbsp;\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-group elementor-column elementor-field-type-submit elementor-col-100 e-form__buttons\">\n\t\t\t\t\t<button class=\"elementor-button elementor-size-sm\" type=\"submit\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Send<\/span>\n\t\t\t\t\t\t\t\t\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/button>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/form>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Intake form Hair transplant \/ Forehead reduction Get your personal free hair plan<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1962","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Intake form - BeautyGainz<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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