{% extends "mediforms/pages/base.html" %} {% load i18n %} {% block content %}
{% csrf_token %} {% block introduction %}{% endblock introduction %}
{% block headline_questionaire %}{% endblock headline_questionaire %}
{{ personal_data_form.first_name.label_tag }} {{ personal_data_form.first_name }} {{ personal_data_form.last_name.label_tag }} {{ personal_data_form.last_name }} {{ personal_data_form.height.label_tag }} {% for error in personal_data_form.height.errors %} {{ error|escape }} {% endfor %} {{ personal_data_form.height }}
{{ personal_data_form.date_of_birth.label_tag }} {% for error in personal_data_form.date_of_birth.errors %} {{ error|escape }} {% endfor %} {% for error in form.date_of_birth.errors %} {{ error|escape }} {% endfor %} {{ personal_data_form.date_of_birth }} {{ personal_data_form.birthplace.label_tag }} {{ personal_data_form.birthplace }} {{ personal_data_form.weight.label_tag }} {{ personal_data_form.weight }}
{{ personal_data_form.gender.label_tag }} {{ personal_data_form.gender }}
{{ personal_data_form.street.label_tag }} {{ personal_data_form.street }} {{ personal_data_form.zip_code.label_tag }} {{ personal_data_form.zip_code }} {{ personal_data_form.city.label_tag }} {{ personal_data_form.city }}
{{ personal_data_form.phone_number.label_tag }} {{ personal_data_form.phone_number }} {{ personal_data_form.mobile_number.label_tag }} {{ personal_data_form.mobile_number }}
{{ personal_data_form.email.label_tag }} {% for error in personal_data_form.email.errors %} {{ error|escape }} {% endfor %} {{ personal_data_form.email }}
{% for field in questions_form %}
{{ forloop.counter }}. {{ field.label_tag }}
{{ field }}
{% endfor %}
{% blocktranslate %}NUR FÜR VERSUCHSTEILNEHMERINNEN:{% endblocktranslate %}
{% for field in questions_form_women %}
{{ field.label_tag }}
{{ field }}
{% endfor %} {% block women_form_extras %}{% endblock women_form_extras %}



{% blocktranslate %}Wenn Sie etwas nicht verstanden haben oder zusätzliche Informationen benötigen, geben wir Ihnen gerne nähere Auskünfte im Gespräch. Bitte fragen Sie uns nach allem, was Ihnen wichtig erscheint.{% endblocktranslate %}

{% url 'data-storage-consent' method.key as data_storage_consent_url %}

{{ consent_agreement_form.agreement_participation }} {% blocktranslate with url=data_storage_consent_url %}Ich bestätige, dass die von mir gemachten Angaben in diesem Fragebogen richtig und vollständig sind und habe die Einwilligung zur Speicherung meiner Daten zur Kenntnis genommen und willige in diese hiermit ein.{% endblocktranslate %}

{{ consent_agreement_form.agreement_consents }} {% block agreement_consents_text %}{% endblock agreement_consents_text %}

{% blocktranslate %}Sind alle Angaben richtig?{% endblocktranslate %}
{% blocktranslate %}Dann drücken Sie bitte jetzt auf "Absenden".{% endblocktranslate %}
{% blocktranslate %}Mit dem Klicken auf "Absenden" werden Ihre Angaben an unsere Studienärztinnen gesendet. Ein Speichern oder Ausdrucken der Unterlagen Ihrerseits ist nicht nötig.{% endblocktranslate %}

{% endblock content %}