{"id":67047,"date":"2025-08-17T15:09:13","date_gmt":"2025-08-17T14:09:13","guid":{"rendered":"https:\/\/www.easly.nl\/dna-paspoort-test-online\/"},"modified":"2025-08-17T15:09:14","modified_gmt":"2025-08-17T14:09:14","slug":"dna-paspoort-test-online","status":"publish","type":"page","link":"https:\/\/www.easly.nl\/en\/dna-paspoort-test-online\/","title":{"rendered":"Questionnaire for DNA passport"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"67047\" class=\"elementor elementor-67047 elementor-60341\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-2eb722a elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"2eb722a\" data-element_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-53f6474\" data-id=\"53f6474\" data-element_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-a1d5adb elementor-widget elementor-widget-shortcode\" data-id=\"a1d5adb\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\t\t<div data-elementor-type=\"section\" data-elementor-id=\"21046\" class=\"elementor elementor-21046 elementor-21039\" data-elementor-post-type=\"elementor_library\">\n\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-51339d6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"51339d6\" data-element_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-aa9d50f\" data-id=\"aa9d50f\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-6238b33 elementor-icon-list--layout-inline elementor-align-center marquee elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"6238b33\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\"><path d=\"M13.3335 4.00016H10.6668V2.66683C10.6668 1.9335 10.0668 1.3335 9.3335 1.3335H6.66683C5.9335 1.3335 5.3335 1.9335 5.3335 2.66683V4.00016H2.66683C1.9335 4.00016 1.3335 4.60016 1.3335 5.3335V13.3335C1.3335 14.0668 1.9335 14.6668 2.66683 14.6668H13.3335C14.0668 14.6668 14.6668 14.0668 14.6668 13.3335V5.3335C14.6668 4.60016 14.0668 4.00016 13.3335 4.00016ZM6.66683 2.66683H9.3335V4.00016H6.66683V2.66683ZM13.3335 13.3335H2.66683V5.3335H13.3335V13.3335Z\" fill=\"#3F3F40\"><\/path><path d=\"M8.66683 6.66683H7.3335V8.66683H5.3335V10.0002H7.3335V12.0002H8.66683V10.0002H10.6668V8.66683H8.66683V6.66683Z\" fill=\"#3F3F40\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Test without referral<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"18\" height=\"18\" viewBox=\"0 0 18 18\" fill=\"none\"><path d=\"M9 4.6425L12.75 8.0175V13.875H11.25V9.375H6.75V13.875H5.25V8.0175L9 4.6425ZM9 2.625L1.5 9.375H3.75V15.375H8.25V10.875H9.75V15.375H14.25V9.375H16.5L9 2.625Z\" fill=\"#3F3F40\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Free shipping on orders over \u20ac50<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\"><path d=\"M15.3332 7.99333L13.7065 6.13333L13.9332 3.67333L11.5265 3.12667L10.2665 1L7.99984 1.97333L5.73317 1L4.47317 3.12667L2.0665 3.66667L2.29317 6.13333L0.666504 7.99333L2.29317 9.85333L2.0665 12.32L4.47317 12.8667L5.73317 15L7.99984 14.02L10.2665 14.9933L11.5265 12.8667L13.9332 12.32L13.7065 9.86L15.3332 7.99333ZM12.6998 8.98L12.3265 9.41333L12.3798 9.98L12.4998 11.28L10.6732 11.6933L10.3798 12.1867L9.71984 13.3067L8.53317 12.7933L7.99984 12.5667L7.47317 12.7933L6.2865 13.3067L5.6265 12.1933L5.33317 11.7L3.5065 11.2867L3.6265 9.98L3.67984 9.41333L3.3065 8.98L2.4465 8L3.3065 7.01333L3.67984 6.58L3.61984 6.00667L3.49984 4.71333L5.3265 4.3L5.61984 3.80667L6.27984 2.68667L7.4665 3.2L7.99984 3.42667L8.5265 3.2L9.71317 2.68667L10.3732 3.80667L10.6665 4.3L12.4932 4.71333L12.3732 6.01333L12.3198 6.58L12.6932 7.01333L13.5532 7.99333L12.6998 8.98Z\" fill=\"#3F3F40\"><\/path><path d=\"M6.7265 9.16667L5.17984 7.61333L4.19317 8.60667L6.7265 11.1467L11.6198 6.24L10.6332 5.24667L6.7265 9.16667Z\" fill=\"#3F3F40\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Processing in ISO accredited lab<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\"><path d=\"M11.0003 13.1465H3.00033V4.99984H7.66699V3.6665H3.00033C2.26699 3.6665 1.66699 4.2665 1.66699 4.99984V12.9998C1.66699 13.7332 2.26699 14.3332 3.00033 14.3332H11.0003C11.7337 14.3332 12.3337 13.7332 12.3337 12.9998V8.33317H11.0003V13.1465Z\" fill=\"#3F3F40\"><\/path><path d=\"M12.3337 1.6665H11.0003V3.6665H9.00033C9.00699 3.67317 9.00033 4.99984 9.00033 4.99984H11.0003V6.99317C11.007 6.99984 12.3337 6.99317 12.3337 6.99317V4.99984H14.3337V3.6665H12.3337V1.6665Z\" fill=\"#3F3F40\"><\/path><path d=\"M9.66699 6.33317H4.33366V7.6665H9.66699V6.33317Z\" fill=\"#3F3F40\"><\/path><path d=\"M4.33366 8.33317V9.6665H9.66699V8.33317H4.33366Z\" fill=\"#3F3F40\"><\/path><path d=\"M9.66699 10.3332H4.33366V11.6665H9.66699V10.3332Z\" fill=\"#3F3F40\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Personal doctor's advice<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"16\" height=\"16\" viewBox=\"0 0 16 16\" fill=\"none\"><path d=\"M10 11.9998H3.33333V3.99984H10V4.6665H11.3333V1.99984C11.3333 1.2665 10.7333 0.666504 10 0.666504H3.33333C2.6 0.666504 2 1.2665 2 1.99984V13.9998C2 14.7332 2.6 15.3332 3.33333 15.3332H10C10.7333 15.3332 11.3333 14.7332 11.3333 13.9998V11.3332H10V11.9998ZM3.33333 1.99984H10V2.6665H3.33333V1.99984ZM10 13.9998H3.33333V13.3332H10V13.9998Z\" fill=\"#3F3F40\"><\/path><path d=\"M12.2533 6.41317L12.6667 7.33317L13.08 6.41317L14 5.99984L13.08 5.5865L12.6667 4.6665L12.2533 5.5865L11.3333 5.99984L12.2533 6.41317Z\" fill=\"#3F3F40\"><\/path><path d=\"M9.33333 5.33317L8.5 7.1665L6.66667 7.99984L8.5 8.83317L9.33333 10.6665L10.1667 8.83317L12 7.99984L10.1667 7.1665L9.33333 5.33317Z\" fill=\"#3F3F40\"><\/path><path d=\"M12.6667 8.6665L12.2533 9.5865L11.3333 9.99984L12.2533 10.4132L12.6667 11.3332L13.08 10.4132L14 9.99984L13.08 9.5865L12.6667 8.6665Z\" fill=\"#3F3F40\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Results in secure app<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\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<\/div>\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<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ac206b1 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ac206b1\" data-element_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-203b54d\" data-id=\"203b54d\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-32b0ad3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"32b0ad3\" data-element_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-50 elementor-inner-column elementor-element elementor-element-7b88614\" data-id=\"7b88614\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-e42fb1d elementor-section-full_width elementor-section-height-default elementor-section-height-default\" data-id=\"e42fb1d\" data-element_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-inner-column elementor-element elementor-element-e6c8eef\" data-id=\"e6c8eef\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-57973aa elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"57973aa\" data-element_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-inner-column elementor-element elementor-element-8cb4467\" data-id=\"8cb4467\" data-element_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-51deef1 elementor-align-left elementor-mobile-align-left button-arrow bottom-position elementor-widget elementor-widget-button\" data-id=\"51deef1\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-xs\" href=\"\/pharmacogenetic-test\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"12\" height=\"10\" viewBox=\"0 0 12 10\" fill=\"none\"><path d=\"M4.92328 1.24447L1.17253 4.99447L4.92328 8.74447M1.17408 4.99447L10.8275 4.99465\" stroke=\"#222426\" stroke-width=\"1.5\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><\/path><\/svg>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">Back<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5b7e5d0 elementor-widget elementor-widget-heading\" data-id=\"5b7e5d0\" data-element_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\">Questionnaire for DNA passport<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-c5ab4f9 elementor-widget elementor-widget-text-editor\" data-id=\"c5ab4f9\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>This questionnaire is a quick and easy tool to determine whether you are eligible for reimbursement for this test.<\/p>\n\t\t\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 class=\"elementor-element elementor-element-bdbf244 elementor-hidden-mobile elementor-widget elementor-widget-image\" data-id=\"bdbf244\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"284\" height=\"338\" src=\"https:\/\/www.easly.nl\/wp-content\/uploads\/sites\/13\/2025\/08\/Phar-DNA.webp\" class=\"attachment-large size-large wp-image-66637\" alt=\"Phar-DNA\" srcset=\"https:\/\/www.easly.nl\/wp-content\/uploads\/sites\/13\/2025\/08\/Phar-DNA.webp 284w, https:\/\/www.easly.nl\/wp-content\/uploads\/sites\/13\/2025\/08\/Phar-DNA-252x300.webp 252w\" sizes=\"(max-width: 284px) 100vw, 284px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d56b8d5 elementor-hidden-desktop elementor-hidden-tablet elementor-widget elementor-widget-image\" data-id=\"d56b8d5\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"342\" height=\"176\" src=\"https:\/\/www.easly.nl\/wp-content\/uploads\/sites\/13\/2025\/08\/Phar-DNA-mob.webp\" class=\"attachment-full size-full wp-image-66642\" alt=\"Phar-DNA-mob\" srcset=\"https:\/\/www.easly.nl\/wp-content\/uploads\/sites\/13\/2025\/08\/Phar-DNA-mob.webp 342w, https:\/\/www.easly.nl\/wp-content\/uploads\/sites\/13\/2025\/08\/Phar-DNA-mob-300x154.webp 300w\" sizes=\"(max-width: 342px) 100vw, 342px\" \/>\t\t\t\t\t\t\t\t\t\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\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-74030b4 qu-column\" data-id=\"74030b4\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\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-e337a71 qu-container elementor-widget elementor-widget-shortcode\" data-id=\"e337a71\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n    <div class=\"progress-container\">\n        <div class=\"step-info\">Stap <span class=\"current-step\">1<\/span> van 6 <\/div>\n        <div class=\"steps\">\n            <div class=\"step\" data-step=\"1\">\n                <div class=\"step-circle\" id=\"stepCircle1\"><\/div>\n                <div class=\"step-name\">E-mail<\/div>\n            <\/div>\n            \n            <div class=\"step\" data-step=\"2\">\n                <div class=\"step-circle\" id=\"stepCircle2\"><\/div>\n                <div class=\"step-name\">Ziektekostenverzekering<\/div>\n            <\/div>\n            \n            <div class=\"step\" data-step=\"3\">\n                <div class=\"step-circle\" id=\"stepCircle3\"><\/div>\n                <div class=\"step-name\">Medicijngebruik<\/div>\n            <\/div>\n            \n            <div class=\"step\" data-step=\"4\">\n                <div class=\"step-circle\" id=\"stepCircle4\"><\/div>\n                <div class=\"step-name\">Medicatieclassificatie<\/div>\n            <\/div>\n            \n            <div class=\"step\" data-step=\"5\">\n                <div class=\"step-circle\" id=\"stepCircle5\"><\/div>\n                <div class=\"step-name\">Bijwerkingen en effectiviteit<\/div>\n            <\/div>\n            \n            <div class=\"step\" data-step=\"6\">\n                <div class=\"step-circle\" id=\"stepCircle6\"><\/div>\n                <div class=\"step-name\">Onderzoek<\/div>\n            <\/div>\n        <\/div>\n    <\/div>\n    \n    <div id=\"dynamic-not-notice\" class=\"not-notice\" style=\"display: none;\">\n        <div class=\"no-insurance-error\">\n            <div class=\"notice-icon\"><\/div>\n            <div class=\"notice-button\">\n                <p>Op dit moment komt u waarschijnlijk niet in aanmerking voor vergoeding door de zorgverzekeraar.<\/p>\n                <p>Heeft u vragen, stuur dan een e-mail naar: <a href=\"mailto:info@easly.nl\" target=\"_blank\">info@easly.nl<\/a><\/p>\n                <a href=\"\/pharmacogenetic-test\"><button id=\"productBtn\">Terug naar de productpagina<\/button><\/a>\n            <\/div>\n        <\/div>\n    <\/div>\n    \n    <!-- Step 1: Email -->\n    <div class=\"step-content active\" id=\"step1\">\n        <div><h2>Wat is uw e-mailadres?<\/h2>\n        <input type=\"email\" id=\"email\" name=\"email-step1\" placeholder=\"Voer uw e-mailadres\" required>\n        <\/div>\n        <div class=\"button-container\" style=\"justify-content: flex-end;\">\n        <button id=\"nextBtn\" class=\"nextBtnStep disabled\" disabled>Volgende<\/button>\n    <\/div>\n    <\/div>\n    \n    <!-- Step 2: Health Insurance -->\n    <div class=\"step-content\" id=\"step2\">\n        <div>\n        <h2>Bent u verzekerd bij een nederlandse zorgverzekeraar?<\/h2>\n        <div class=\"radio-group\">\n            <div class=\"radio-option\">\n                <input type=\"radio\" id=\"insuranceYes\" name=\"insurance\" value=\"yes\">\n                <label for=\"insuranceYes\">Ja<\/label>\n            <\/div>\n            <div class=\"radio-option\">\n                <input type=\"radio\" id=\"insuranceNo\" name=\"insurance\" value=\"no\">\n                <label for=\"insuranceNo\">Nee<\/label>\n            <\/div>\n        <\/div>\n        <div class=\"notice\" id=\"insuranceNotice\">\n            At this time, you are probably not eligible for reimbursement from your health insurer.\n        <\/div>\n        <\/div>\n        <div class=\"button-container\">\n            <button id=\"backBtn\" class=\"backBtnStep\">Terug<\/button>\n            <button id=\"nextBtn\" class=\"nextBtnStep\">Volgende<\/button>\n        <\/div>\n    <\/div>\n    \n    <!-- Step 3: Medication Use -->\n    <div class=\"step-content\" id=\"step3\">\n        <div>\n        <h2>Gebruikt u medicatie?<\/h2>\n        <div class=\"radio-group\">\n            <div class=\"radio-option\">\n                <input type=\"radio\" id=\"medicationYes\" name=\"medication\" value=\"yes\">\n                <label for=\"medicationYes\">Ja<\/label>\n            <\/div>\n            <div class=\"radio-option\">\n                <input type=\"radio\" id=\"medicationNo\" name=\"medication\" value=\"no\">\n                <label for=\"medicationNo\">Nee<\/label>\n            <\/div>\n        <\/div>\n        <div class=\"notice\" id=\"medicationNotice\">\n            At this time, you are probably not eligible for reimbursement from your health insurer.\n        <\/div>\n        <\/div>\n        <div class=\"button-container\">\n            <button id=\"backBtn\" class=\"backBtnStep\">Terug<\/button>\n            <button id=\"nextBtn\" class=\"nextBtnStep\">Volgende<\/button>\n        <\/div>\n    <\/div>\n    \n    <!-- Step 4: Medication classification -->\n    <div class=\"step-content\" id=\"step4\">\n        <div>\n        <h2>Vallen uw medicijnen in een van onderstaande groepen?<\/h2>\n        <div class=\"checkbox-group\">\n            <div class=\"checkbox-option\">\n                <input type=\"checkbox\" id=\"medA\" name=\"medicationType\" value=\"Cholesterolverlagers\">\n                <label for=\"medA\">Cholesterolverlagers  <span>(bijv. simvastatine, astorvastatine etc.)<\/span><\/label>\n            <\/div>\n            <div class=\"checkbox-option\">\n                <input type=\"checkbox\" id=\"medB\" name=\"medicationType\" value=\"Bloedverdunners\">\n                <label for=\"medB\">Bloedverdunners <span>(bijv. clopidogrel, acenocoumarol, metoprolol etc.)<\/span><\/label>\n            <\/div>\n            <div class=\"checkbox-option\">\n                <input type=\"checkbox\" id=\"medC\" name=\"medicationType\" value=\"Zware pijnstillers\">\n                <label for=\"medC\">Zware pijnstillers<span>(bijv. tramadol, code\u00efne, oxycodon)<\/span><\/label>\n            <\/div>\n            <div class=\"checkbox-option\">\n                <input type=\"checkbox\" id=\"medD\" name=\"medicationType\" value=\"Antidepressiva & Antipsychotica\">\n                <label for=\"medD\">Antidepressiva & Antipsychotica <span>(bijv.  paroxetine, nortriptyline, sertraline, etc.)<\/span><\/label>\n            <\/div>\n            <div class=\"checkbox-option\">\n                <input type=\"checkbox\" id=\"medE\" name=\"medicationType\" value=\"Maagbeschermers\">\n                <label for=\"medE\">Maagbeschermers <span>(bijv. pantoprazol, omeprazol, etc.)<\/span><\/label>\n            <\/div>\n            <div class=\"checkbox-option\">\n                <input type=\"checkbox\" id=\"medF\" name=\"medicationType\" value=\"Anders\">\n                <label for=\"medF\">Anders, namelijk\u2026<\/label>\n                <input type=\"text\" id=\"otherMedication\" class=\"other-input\" placeholder=\"Typ medicijnnamen\">\n            <\/div>\n        <\/div>\n        <\/div>\n        <div class=\"button-container\">\n            <button id=\"backBtn\" class=\"backBtnStep\">Terug<\/button>\n            <button id=\"nextBtn\" class=\"nextBtnStep\">Volgende<\/button>\n        <\/div>\n    <\/div>\n    \n    <!-- Step 5: Side Effects and Effectiveness -->\n    <div class=\"step-content\" id=\"step5\">\n        <div>\n        <h2>Heeft u bijwerkingen van uw medicatie?<\/h2>\n        <div class=\"radio-group\">\n            <div class=\"radio-option\">\n                <input type=\"radio\" id=\"sideEffectsYes\" name=\"sideEffects\" value=\"yes\">\n                <label for=\"sideEffectsYes\">Ja<\/label>\n            <\/div>\n            <div class=\"radio-option\">\n                <input type=\"radio\" id=\"sideEffectsNo\" name=\"sideEffects\" value=\"no\">\n                <label for=\"sideEffectsNo\">Nee<\/label>\n            <\/div>\n        <\/div>\n        \n        <h2>Heeft u het gevoel dat de medicatie effectief werkt?<\/h2>\n        <div class=\"radio-group\">\n            <div class=\"radio-option\">\n                <input type=\"radio\" id=\"effectiveYes\" name=\"effective\" value=\"yes\">\n                <label for=\"effectiveYes\">Ja<\/label>\n            <\/div>\n            <div class=\"radio-option\">\n                <input type=\"radio\" id=\"effectiveNo\" name=\"effective\" value=\"no\">\n                <label for=\"effectiveNo\">Nee<\/label>\n            <\/div>\n        <\/div>\n        <\/div>\n        <div class=\"button-container\">\n            <button id=\"backBtn\" class=\"backBtnStep\">Terug<\/button>\n            <button id=\"nextBtn\" class=\"nextBtnStep\">Volgende<\/button>\n        <\/div>\n    <\/div>\n    \n    <!-- Step 6: Assessment -->\n    <div class=\"step-content\" id=\"step6\">\n        <div>\n            <div class=\"notice-step6\">\n                <div class=\"notice-step6-icon\"><\/div>\n                <div class=\"notice-button\">\n                    <p>De kans is groot dat u recht hebt op vergoeding door uw ziektekostenverzekeraar.<\/p>\n                <\/div>\n            <\/div>\n            <h2>Vul onderstaande gegevens in en verzend het formulier<\/h2>\n            <p class=\"descr\">Wij nemen dan zsm contact met u op.<\/p>\n            <div class=\"qu-contact-form\">\n            \n                <label for=\"firstName\">Voornaam<\/label>\n                <input type=\"text\" id=\"firstName\" placeholder=\"Voornaam\" required>\n                <label for=\"lastName\">Achternaam<\/label>\n                <input type=\"text\" id=\"lastName\" placeholder=\"Achternaam\" required>\n                <label for=\"confirmEmail\">E-mail<\/label>\n                <input type=\"email\" id=\"confirmEmail\" placeholder=\"E-mail\" required>\n                <label for=\"phone\">Telefoon<\/label>\n                <input type=\"tel\" id=\"phone\" placeholder=\"Telefoon\" required>\n                <label for=\"comment\">Commentaar<\/label>\n                <textarea id=\"comment\" placeholder=\"Commentaar (optioneel)\"><\/textarea>\n    \n            <\/div>\n        <\/div>\n        <div class=\"button-container\">\n            <button id=\"backBtn\" class=\"backBtnStep\">Terug<\/button>\n            <button id=\"nextBtn\" class=\"nextBtnStep\">Volgende<\/button>\n        <\/div>\n    <\/div>\n    \n    <!-- Step 7: Final Screen -->\n    <div class=\"step-content final-screen\" id=\"step7\">\n        <img decoding=\"async\" src=\"https:\/\/www.easly.nl\/wp-content\/uploads\/sites\/13\/2025\/05\/Frame-427322416-1.png\" alt=\"Questionnaire pass\" width=\"104\" height=\"104\" \/>\n        <h2>Bedankt voor je aanvraag.<\/h2>\n        <div class=\"desc\">\n        <p>We hebben uw verzoek goed ontvangen.<\/p>\n        <p>We nemen zo snel mogelijk contact met u op.<\/p>\n        <\/div>\n        <div>\n            <strong style=\"font-weight: 500;\">  Geef deze brief aan uw huisarts om Farmacogenetica te overwegen <\/strong>\n        <\/div>\n        <a href=\"\/wp-content\/uploads\/sites\/13\/2025\/07\/Huisartsenbrief.pdf\" class=\"last-step-download\" target=\"_blank\">brief downloaden <img decoding=\"async\" src=\"\/wp-content\/uploads\/sites\/13\/2024\/12\/Vector.svg\" \/><\/a><br>\n        <a href=\"\/pharmacogenetic-test\"><button id=\"productBtn\">Terug naar de productpagina<\/button><\/a>\n    <\/div>\n\n    <style>\n        .last-step-download {\n            display: flex;\n            width: 100%;\n            justify-content: center;\n            align-items: center;\n            padding: 5px;\n            color:#FF3D54;\n            margin-top: 7px;\n        }\n        .last-step-download img {\n            margin:0px 5px;\n        }\n    .qu-column.on-step7 .elementor-widget-wrap {\n        box-shadow: 0px 0px 108px 0px #99D7DD66 inset;\n        border: none !important;\n        background-color: none !important;\n    }\n    .qu-container {\n        padding: 24px;\n        font-family: \"Work Sans\";\n        height: 100%;\n    }\n\n    .qu-container .elementor-widget-container{\n        display: flex;\n        flex-direction: column;\n        align-content: flex-start;\n        justify-content: space-between;\n        height: 100%;\n    }\n\n    .step-info{\n       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  .notice-icon {\n        background-image: url(https:\/\/www.easly.nl\/wp-content\/uploads\/sites\/13\/2025\/04\/Info-outlined.svg);\n        width: 40px;\n        margin-right: 12px;\n        display: block;\n        background-position: top;\n        background-repeat: no-repeat;\n    }\n\n    .notice-button p a {\n        color: #000000;\n        text-decoration: underline;\n    }\n\n    .notice {\n        padding: 15px;\n        background: #fff3cd;\n        color: #856404;\n        border-radius: 4px;\n        margin: 20px 0;\n        display: none;\n    }\n\n    .notice-step6 {\n        background: #EAF5F8;\n        color: #000000;\n        font-weight: 500;\n        font-size: 14px;\n        line-height: 140%;\n        letter-spacing: -1%;\n        vertical-align: middle;\n        padding: 19px 12px;\n        border-radius: 8px;\n        display: flex;\n        max-width: 655px;\n        margin-bottom: 32px;\n    }\n\n    .notice-step6-icon {\n        background-image: 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