krankenzusatz.versicherungs-profi.com Open in urlscan Pro
35.214.29.180  Public Scan

Form analysis
1 forms found in the DOM

POST /form-submission

<form action="/form-submission" method="POST" id="questions-form" class="loaded">
  <input type="hidden" name="__pg_id" value="10">
  <input type="hidden" name="__start" value="1713979070">
  <input type="hidden" name="__dsh" value="ac">
  <input type="hidden" name="__dsh_id" value="dW93UWV3RkRKUHJESmhneHFaWjBOQT09">
  <input type="hidden" name="__ty" value="https://krankenzusatz.versicherungs-profi.com/thankyou/">
  <div class="progress">
    <div class="progress-bar" style="width: 0%;">
      <div></div>
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    <div class="progress-text"> Completed: <span id="progress-value">0</span> % </div>
  </div>
  <div class="question-blocks static" style="height: 192px;">
    <div class="question-block active static" data-position="first" data-height="192">
      <div class="questions">
        <div class="question label-align-left" data-type="radio" data-name="cover_type" data-validation="default" data-message="Bitte wählen Sie eine Option aus" data-validity="unknown">
          <div class="question-label">
            <div class="question-label-text"> Wie sind Sie krankenversichert? </div>
          </div>
          <div class="question-input-container">
            <div class="radio-buttons "> <label class="radio-button">
                <input type="radio" value="legal" name="cover_type">
                <span>Gesetzlich</span>
              </label>
              <label class="radio-button">
                <input type="radio" value="private" name="cover_type">
                <span>Privat</span>
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              <label class="radio-button">
                <input type="radio" value="voluntary" name="cover_type">
                <span>Freiwillig</span>
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          <div class="question-validation"></div>
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      <button type="button" onclick="progressForm()">Weiter</button>
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    <div class="question-block" data-position="middle" data-height="192">
      <div class="questions">
        <div class="question label-align-left" data-type="boolean" data-name="free_choice_imporant" data-validation="default" data-message="Bitte wählen Sie eine Option aus" data-validity="unknown">
          <div class="question-label">
            <div class="question-label-text"> Ist Ihnen eine freie Arzt und Klinikwahl wichtig? </div>
          </div>
          <div class="question-input-container">
            <div class="radio-buttons"> <label class="radio-button">
                <input type="radio" value="Yes" name="free_choice_imporant">
                <span>Ja</span>
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              <label class="radio-button">
                <input type="radio" value="No" name="free_choice_imporant">
                <span>Nein</span>
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          <div class="question-validation"></div>
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      <button type="button" onclick="progressForm()">Weiter</button>
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    <div class="question-block" data-position="middle" data-height="192">
      <div class="questions">
        <div class="question label-align-left" data-type="boolean" data-name="one_two_bed_important" data-validation="default" data-message="Bitte wählen Sie eine Option aus" data-validity="unknown">
          <div class="question-label">
            <div class="question-label-text"> Ist Ihnen ein 1- oder 2 Bettzimmer im Krankenhaus wichtig? </div>
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          <div class="question-input-container">
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                <input type="radio" value="Yes" name="one_two_bed_important">
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                <span>Nein</span>
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      <button type="button" onclick="progressForm()">Weiter</button>
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    <div class="question-block" data-position="middle" data-height="289">
      <div class="questions">
        <div class="question label-align-left" data-type="full_name" data-name="full_name" data-validation="default" data-message="This field is required" data-validity="unknown">
          <div class="question-label">
            <div class="question-label-text"> Wie lautet Ihr Name? </div>
          </div>
          <div class="question-input-container">
            <input type="text" name="full_name" placeholder="" value="">
          </div>
          <div class="question-validation"></div>
        </div>
        <div class="question label-align-left" data-type="date" data-name="dob" data-validation="default" data-message="This field is required" data-validity="unknown">
          <div class="question-label">
            <div class="question-label-text"> Geburtsdatum </div>
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          <div class="question-input-container">
            <input type="date" name="dob" placeholder="" value="">
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          <div class="question-validation"></div>
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      <button type="button" onclick="progressForm()">Weiter</button>
    </div>
    <div class="question-block" data-position="middle" data-height="181">
      <div class="questions">
        <div class="question label-align-left" data-type="postcode" data-name="postcode" data-validation="default" data-message="This field is required" data-validity="unknown">
          <div class="question-label">
            <div class="question-label-text"> Wie lautet Ihre Adresse? </div>
          </div>
          <div class="question-input-container">
            <input type="text" name="postcode" placeholder="" value="" oninput="this.value = this.value.toUpperCase()">
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          <div class="question-validation"></div>
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      <button type="button" onclick="progressForm()">Weiter</button>
    </div>
    <div class="question-block" data-position="last" data-height="338.188">
      <div class="questions">
        <div class="question label-align-left" data-type="phone" data-name="phone" data-validation="default" data-message="This field is required" data-validity="unknown">
          <div class="question-title">Wie können wir Sie erreichen?</div>
          <div class="question-label">
            <div class="question-label-text"> Telefonnummer </div>
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          <div class="question-input-container">
            <input type="text" name="phone" placeholder="" value="" inputmode="numeric" pattern="\+?[0-9 ]+">
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          <div class="question-validation"></div>
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        <div class="question label-align-left" data-type="email" data-name="email" data-validation="default" data-message="This field is required" data-validity="unknown">
          <div class="question-label">
            <div class="question-label-text"> E-Mail-Adresse </div>
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          <div class="question-input-container">
            <input type="email" name="email" placeholder="" value="">
          </div>
          <div class="question-validation"></div>
        </div>
      </div>
      <button type="button" onclick="progressForm()">Preis anfordern</button>
    </div>
  </div>
  <div class="form-back" onclick="showPrevQuestion()" style="display: none;">Zurück</div>
</form>

Text Content

BESSERE VORTEILE ALS PRIVATPATIENT BEKOMMEN

Completed: 0 %
Wie sind Sie krankenversichert?
Gesetzlich Privat Freiwillig

Weiter
Ist Ihnen eine freie Arzt und Klinikwahl wichtig?
Ja Nein

Weiter
Ist Ihnen ein 1- oder 2 Bettzimmer im Krankenhaus wichtig?
Ja Nein

Weiter
Wie lautet Ihr Name?


Geburtsdatum


Weiter
Wie lautet Ihre Adresse?


Weiter
Wie können wir Sie erreichen?
Telefonnummer


E-Mail-Adresse


Preis anfordern
Zurück
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