{"id":2529,"date":"2023-07-28T08:00:00","date_gmt":"2023-07-28T06:00:00","guid":{"rendered":"https:\/\/spielzeit.ch\/form\/"},"modified":"2026-08-25T07:53:08","modified_gmt":"2026-08-25T05:53:08","slug":"form","status":"publish","type":"page","link":"https:\/\/spielzeit.ch\/en\/contact-us\/form\/","title":{"rendered":"Form"},"content":{"rendered":"\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-8f761849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:77.5%\">\n<h2 class=\"wp-block-heading\">Contact Form<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">We look forward to hearing from you.<br\/>We ask professionals and insurance companies to use the email address <a href=\"mailto:spielzeit@hin.ch\">spielzeit@hin.ch<\/a>.<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-contact-form-7-contact-form-selector\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f4992-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"4992\">\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\/2529#wpcf7-f4992-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"4992\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.7\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f4992-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<p><small><span style=\"color: red;\">*<\/span> = Required field<\/small>\n<\/p>\n<h3>Contact Person \/ Legal Guardian\n<\/h3>\n<p style=\"margin-bottom: 0 !important;\">\n<\/p>\n<p><label> Title<span>*<\/span><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"sex\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">Mr.<\/span><input type=\"radio\" name=\"sex\" value=\"Mr.\" checked=\"checked\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">Ms.<\/span><input type=\"radio\" name=\"sex\" value=\"Ms.\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">Other<\/span><input type=\"radio\" name=\"sex\" value=\"Other\" \/><\/label><\/span><\/span><\/span>\n<\/p>\n<div class=\"form-cols\">\n\t<div class=\"form-col-50\">\n\t\t<p><label> First Name<span>*<\/span><br \/>\n<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=\"given-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First Name\" value=\"\" type=\"text\" name=\"firstname\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-col-50\">\n\t\t<p><label> Last Name<span>*<\/span><br \/>\n<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=\"family-name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name\" value=\"\" type=\"text\" name=\"lastname\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label> Street\/No.<span>*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"street\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"street-address\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Street and house number\" value=\"\" type=\"text\" name=\"street\" \/><\/span> <\/label>\n<\/p>\n<div class=\"form-cols\">\n\t<div class=\"form-col-33\">\n\t\t<p><label> ZIP Code<span>*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"zip\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"postal-code\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"e.g., 8044\" value=\"\" type=\"text\" name=\"zip\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-col-66\">\n\t\t<p><label> City<span>*<\/span><br \/>\n<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=\"address-level2\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"e.g., Zurich\" value=\"\" type=\"text\" name=\"city\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-cols\">\n\t<div class=\"form-col-50\">\n\t\t<p><label> Email Address<span>*<\/span><br \/>\n<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.g., your.email@example.com\" value=\"\" type=\"email\" name=\"email\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-col-50\">\n\t\t<p><label> Phone Number<span>*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" autocomplete=\"tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"+41 ...\" value=\"\" type=\"text\" name=\"tel\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label> Relationship to The Patient<span>*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"relation\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"relation\"><option value=\"\">Please select...<\/option><option value=\"Mother\">Mother<\/option><option value=\"Father\">Father<\/option><option value=\"Legal guardian\">Legal guardian<\/option><option value=\"Self (patient)\">Self (patient)<\/option><option value=\"Healthcare professional \/ Referring physician\">Healthcare professional \/ Referring physician<\/option><option value=\"Other\">Other<\/option><\/select><\/span> <\/label>\n<\/p>\n<p style=\"margin-bottom: 0 !important;\">\n<\/p>\n<h3>Patient Information\n<\/h3>\n<p style=\"margin-bottom: 0 !important;\">\n<\/p>\n<p><label> Patient's Gender<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-sex\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><span class=\"wpcf7-list-item-label\">Male<\/span><input type=\"radio\" name=\"patient-sex\" value=\"Male\" checked=\"checked\" \/><\/label><\/span><span class=\"wpcf7-list-item\"><label><span class=\"wpcf7-list-item-label\">Female<\/span><input type=\"radio\" name=\"patient-sex\" value=\"Female\" \/><\/label><\/span><span class=\"wpcf7-list-item last\"><label><span class=\"wpcf7-list-item-label\">Other<\/span><input type=\"radio\" name=\"patient-sex\" value=\"Other\" \/><\/label><\/span><\/span><\/span>\n<\/p>\n<div class=\"form-cols\">\n\t<div class=\"form-col-50\">\n\t\t<p><label> Patient's First Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-firstname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"First Name\" value=\"\" type=\"text\" name=\"patient-firstname\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-col-50\">\n\t\t<p><label> Patient's Last Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-lastname\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Last Name\" value=\"\" type=\"text\" name=\"patient-lastname\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"form-cols\">\n\t<div class=\"form-col-50\">\n\t\t<p><label> Patient's Date of Birth<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-dob\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"patient-dob\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-col-50\">\n\t\t<p><label> Age (years)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"e.g., 9\" value=\"\" type=\"text\" name=\"patient-age\" \/><\/span> <\/label>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<p><label> Native Language<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-lang\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"e.g., German\" value=\"\" type=\"text\" name=\"patient-lang\" \/><\/span> <\/label>\n<\/p>\n<p><label> Known diagnosis(es)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patient-diagnosis\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"e.g., ADHD, autism spectrum, none\" value=\"\" type=\"text\" name=\"patient-diagnosis\" \/><\/span> <small style=\"font-weight: normal; margin-top: 0.125rem;\">If applicable, separate multiple diagnoses with commas.<\/small><\/label>\n<\/p>\n<p style=\"margin-bottom: 0 !important;\">\n<\/p>\n<h3>Your Inquiry\n<\/h3>\n<p style=\"margin-bottom: 0 !important;\">\n<\/p>\n<p><label> Type of Inquiry<span>*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"type\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"type\"><option value=\"\">Please select...<\/option><option value=\"Psychotherapy Registration\">Psychotherapy Registration<\/option><option value=\"Assessment\/Diagnostics Registration\">Assessment\/Diagnostics Registration<\/option><option value=\"Parenting Counseling\">Parenting Counseling<\/option><option value=\"Request for Documents\">Request for Documents<\/option><option value=\"Professional Inquiry\">Professional Inquiry<\/option><option value=\"Other\">Other<\/option><\/select><\/span> <\/label>\n<\/p>\n<p><label> Your Inquiry \/<span> Message*<\/span><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"message\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please describe your inquiry, the reason for your request, and any other relevant information ...\" name=\"message\"><\/textarea><\/span> <small style=\"font-weight: normal; margin-top: 0.125rem;\">Max. 2,000 characters <\/small><\/label><label> Referring Professional (if applicable)<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"fachperson\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Name and title of the referring professional\" value=\"\" type=\"text\" name=\"fachperson\" \/><\/span> <\/label>\n<\/p>\n<p><label style=\"margin-bottom: 0;\"> Please upload relevant documents here<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"upload\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.jpg,.jpeg,.png,.gif,application\/pdf,image\/jpeg,image\/png,image\/gif\" aria-invalid=\"false\" type=\"file\" name=\"upload\" \/><\/span> <small style=\"font-weight: normal; margin-top: 0.125rem; margin-bottom: 0.5rem;\"> Max. 4 MB (PDF, JPG, PNG) <\/small><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"upload2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.jpg,.jpeg,.png,.gif,application\/pdf,image\/jpeg,image\/png,image\/gif\" aria-invalid=\"false\" type=\"file\" name=\"upload2\" \/><\/span><small style=\"font-weight: normal; margin-top: 0.125rem; margin-bottom: 0.5rem;\"> Max. 4 MB (PDF, JPG, PNG) <\/small><span class=\"wpcf7-form-control-wrap\" data-name=\"upload3\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\".pdf,.jpg,.jpeg,.png,.gif,application\/pdf,image\/jpeg,image\/png,image\/gif\" aria-invalid=\"false\" type=\"file\" name=\"upload3\" \/><\/span><small style=\"font-weight: normal; margin-top: 0.125rem;\"> Max. 4 MB (PDF, JPG, PNG) <\/small>\n<\/p>\n<p style=\"margin-bottom: 0 !important;\">\n<\/p>\n<h3>Privacy & Consent\n<\/h3>\n<p style=\"margin-bottom: 0 !important;\">\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"agb\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"agb\" value=\"1\" aria-invalid=\"false\" \/><span class=\"wpcf7-list-item-label\">I have read the <a href=\"https:\/\/spielzeit.ch\/en\/privacy\/\" title=\"Privacy Policy\">Privacy Policy<\/a> and consent to the processing of my data for the purpose of contacting me.<span>*<\/span><\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p style=\"margin-bottom: 0 !important;\">\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\n\n\n<div style=\"height:100px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Contact Form We look forward to hearing from you.We ask professionals and insurance companies to use the email address spielzeit@hin.ch.<\/p>\n","protected":false},"author":1,"featured_media":6069,"parent":2547,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-2529","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Form - spielzeit<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/spielzeit.ch\/en\/contact-us\/form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta 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