{"id":1482,"date":"2026-07-14T12:31:31","date_gmt":"2026-07-14T10:31:31","guid":{"rendered":"https:\/\/www.mynovva.de\/questionnaire\/"},"modified":"2026-08-25T15:07:57","modified_gmt":"2026-08-25T13:07:57","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/www.mynovva.de\/en\/questionnaire\/","title":{"rendered":"Questionnaire"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1482\" class=\"elementor elementor-1482 elementor-899\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-310f1d4 e-con-full mygrad e-flex e-con e-parent\" data-id=\"310f1d4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div class=\"elementor-element elementor-element-e43fb98 e-flex e-con-boxed e-con e-child\" data-id=\"e43fb98\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-43fa912 e-con-full e-flex e-con e-child\" data-id=\"43fa912\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-703a998 elementor-widget elementor-widget-shortcode\" data-id=\"703a998\" data-element_type=\"widget\" data-e-type=\"widget\" id=\"myform\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><div class='fluentform ff-default fluentform_wrapper_4 ffs_modern_l_wrap'><form data-form_id=\"4\" id=\"fluentform_4\" class=\"frm-fluent-form fluent_form_4 ff-el-form-top ff_form_instance_4_1 ff-form-loading ff-form-has-steps ff_calc_form ff_has_stripe_inline fluentform_has_payment ffs_modern_l\" data-form_instance=\"ff_form_instance_4_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">NOVVA Medizinischer Eignungsfragebogen<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='1482' \/><input type=\"hidden\" id=\"_fluentform_4_fluentformnonce\" name=\"_fluentform_4_fluentformnonce\" value=\"1e8c50ff77\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/1482\" \/><div class='ff-step-container' data-name=\"step_start-4_21\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"yes\" data-enable_step_page_resume=\"no\" data-animation_type=\"slide\" data-progress_layout=\"top\" data-progress_indicator=\"progress-bar\" ><div class='ff-step-header ff-step-header--progress'><div class='ff-step-progress-wrap'><div class='ff-el-progress-status' aria-live='polite'><\/div><div class='ff-el-progress'><div role='progressbar' class='ff-el-progress-bar'><span><\/span><\/div><\/div><ul style='display: none' class='ff-el-progress-title'><li>Welcome<\/li><li>Weight-Loss Medications<\/li><li>Size<\/li><li>Weight<\/li><li>Date of Birth<\/li><li>Gender  <\/li><li>Ethnic Background  <\/li><li>Taking Medication<\/li><li>Pre-existing conditions<\/li><li>Concomitant conditions<\/li><li>Allergies  <\/li><li>NOVVA<\/li><li>Preliminary Results<\/li><li>Personal Information<\/li><li>Summary<\/li><li>Costs<\/li><\/ul><\/div><\/div><span class='ff_step_start'><\/span><div class='ff-step-body'><div class=\"fluentform-step active\" data-name=\"step_start-4_21\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"yes\" data-enable_step_page_resume=\"no\" data-animation_type=\"slide\" data-progress_layout=\"top\" data-progress_indicator=\"progress-bar\" ><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_1\" ><p>Please answer a few medical questions so that our specialists can assess your eligibility and tailor your treatment to your individual needs. Your information will, of course, be kept confidential. <\/p><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_2\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Have you taken prescription weight-loss medications in the past?\">Have you taken prescription weight-loss medications in the past?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='fruehere_medikamente_17b1104b4aeb1f45f2f3b564926073db'><input  type=\"radio\" name=\"fruehere_medikamente\" data-name=\"fruehere_medikamente\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"wegovy\"  id='fruehere_medikamente_17b1104b4aeb1f45f2f3b564926073db' aria-label='Yes, Wegovy\u00ae' aria-invalid='false' aria-required=true> <span>Yes, Wegovy\u00ae<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='fruehere_medikamente_7eab5dd495ae1678c71cbe9cdca783e8'><input  type=\"radio\" name=\"fruehere_medikamente\" data-name=\"fruehere_medikamente\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"ozempic\"  id='fruehere_medikamente_7eab5dd495ae1678c71cbe9cdca783e8' aria-label='Yes, Ozempic\u00ae' aria-invalid='false' aria-required=true> <span>Yes, Ozempic\u00ae<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='fruehere_medikamente_5d69aac0e9664a69e0a3131ea46f76ba'><input  type=\"radio\" name=\"fruehere_medikamente\" data-name=\"fruehere_medikamente\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"saxenda\"  id='fruehere_medikamente_5d69aac0e9664a69e0a3131ea46f76ba' aria-label='Yes, Saxenda\u00ae' aria-invalid='false' aria-required=true> <span>Yes, Saxenda\u00ae<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='fruehere_medikamente_26209a92ac1dc2d2ebb09c535224b306'><input  type=\"radio\" name=\"fruehere_medikamente\" data-name=\"fruehere_medikamente\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"keine\"  id='fruehere_medikamente_26209a92ac1dc2d2ebb09c535224b306' aria-label='No, not yet' aria-invalid='false' aria-required=true> <span>No, not yet<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='fruehere_medikamente_25007b9ee5a7f02816c953725cf2acbb'><input  type=\"radio\" name=\"fruehere_medikamente\" data-name=\"fruehere_medikamente\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"andere\"  id='fruehere_medikamente_25007b9ee5a7f02816c953725cf2acbb' aria-label='Other Medications' aria-invalid='false' aria-required=true> <span>Other Medications<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_fruehere_medikamente_andere' id='label_ff_4_fruehere_medikamente_andere' aria-label=\"What other medications have you taken?\">What other medications have you taken?<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_4_fruehere_medikamente_andere\" name=\"fruehere_medikamente_andere\" id=\"ff_4_fruehere_medikamente_andere\" class=\"ff-el-form-control\" placeholder=\"Please name the medication...\" rows=\"2\" cols=\"2\" data-name=\"fruehere_medikamente_andere\" ><\/textarea><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_3\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_numeric_field_1' id='label_ff_4_numeric_field_1' aria-label=\"How tall are you? (in cm)\">How tall are you? (in cm) <\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric_field_1\" id=\"ff_4_numeric_field_1\" class=\"ff-el-form-control\" data-name=\"numeric_field_1\" inputmode=\"numeric\" step=\"any\" min=\"50\" aria-valuemin=\"50\" max=\"250\" aria-valuemax=\"250\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">cm<\/span><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_4\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_numeric_field_2' id='label_ff_4_numeric_field_2' aria-label=\"How much do you currently weigh? (in kg)\">How much do you currently weigh? (in kg) <\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"number\" name=\"numeric_field_2\" id=\"ff_4_numeric_field_2\" class=\"ff-el-form-control\" data-name=\"numeric_field_2\" inputmode=\"numeric\" step=\"any\" min=\"30\" aria-valuemin=\"30\" max=\"400\" aria-valuemax=\"400\"  aria-invalid=\"false\" aria-required=true><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">kg<\/span><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_5\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_input_mask' id='label_ff_4_input_mask' aria-label=\"What is your date of birth?\">What is your date of birth?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_mask\" data-mask=\"00.00.0000\" class=\"ff-el-form-control\" placeholder=\"DD.MM.YYYY\" data-name=\"input_mask\" inputmode=\"numeric\" id=\"ff_4_input_mask\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_6\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Please select your biological sex:\">Please select your biological sex:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='geschlecht_00c8185a1c1f93c15c491406d60410be'><input  type=\"radio\" name=\"geschlecht\" data-name=\"geschlecht\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"weiblich\"  id='geschlecht_00c8185a1c1f93c15c491406d60410be' aria-label='Female' aria-invalid='false' aria-required=true> <span>Female<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='geschlecht_89632cdf3b01785d6b24be5ce767866d'><input  type=\"radio\" name=\"geschlecht\" data-name=\"geschlecht\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"maennlich\"  id='geschlecht_89632cdf3b01785d6b24be5ce767866d' aria-label='Male' aria-invalid='false' aria-required=true> <span>Male<\/span><\/label><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_7\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"What is your ethnic background? (Multiple selections allowed)\">What is your ethnic background? (Multiple selections allowed) <\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='ethnizitaet_a9f274faa8ff87f25fdfac8075055406'><input  type=\"checkbox\" name=\"ethnizitaet[]\" data-name=\"ethnizitaet\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"weiss\"  id='ethnizitaet_a9f274faa8ff87f25fdfac8075055406' aria-label='White \/ Caucasian' aria-invalid='false' aria-required=true> <span>White \/ Caucasian<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='ethnizitaet_8e2c2f021972b65d95aa518eefad0b22'><input  type=\"checkbox\" name=\"ethnizitaet[]\" data-name=\"ethnizitaet\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"schwarz\"  id='ethnizitaet_8e2c2f021972b65d95aa518eefad0b22' aria-label='Black \/ African' aria-invalid='false' aria-required=true> <span>Black \/ African<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='ethnizitaet_3b0df4471efdee85fdb42f6989da482d'><input  type=\"checkbox\" name=\"ethnizitaet[]\" data-name=\"ethnizitaet\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"asiatisch\"  id='ethnizitaet_3b0df4471efdee85fdb42f6989da482d' aria-label='Asian' aria-invalid='false' aria-required=true> <span>Asian<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='ethnizitaet_c444c14630756da9f24e10692734a774'><input  type=\"checkbox\" name=\"ethnizitaet[]\" data-name=\"ethnizitaet\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"hispanisch\"  id='ethnizitaet_c444c14630756da9f24e10692734a774' aria-label='Hispanic \/ Latino' aria-invalid='false' aria-required=true> <span>Hispanic \/ Latino<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='ethnizitaet_5726bd49a22ebf5416fde64b2fd06307'><input  type=\"checkbox\" name=\"ethnizitaet[]\" data-name=\"ethnizitaet\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"andere\"  id='ethnizitaet_5726bd49a22ebf5416fde64b2fd06307' aria-label='Different background' aria-invalid='false' aria-required=true> <span>Different background<\/span><\/label><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_8\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Are you currently taking any medications on a regular basis?\">Are you currently taking any medications on a regular basis?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='aktuelle_medikamente_status_c8f572f5db29216f28e62d88d4028026'><input  type=\"radio\" name=\"aktuelle_medikamente_status\" data-name=\"aktuelle_medikamente_status\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"ja\"  id='aktuelle_medikamente_status_c8f572f5db29216f28e62d88d4028026' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='aktuelle_medikamente_status_7b5351e64febe94ce9800a8bdfe4644e'><input  type=\"radio\" name=\"aktuelle_medikamente_status\" data-name=\"aktuelle_medikamente_status\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"nein\"  id='aktuelle_medikamente_status_7b5351e64febe94ce9800a8bdfe4644e' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_aktuelle_medikamente_details' id='label_ff_4_aktuelle_medikamente_details' aria-label=\"Please list the medications you are currently taking:\">Please list the medications you are currently taking:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_4_aktuelle_medikamente_details\" name=\"aktuelle_medikamente_details\" id=\"ff_4_aktuelle_medikamente_details\" class=\"ff-el-form-control\" placeholder=\"Please list all medications and dosages...\" rows=\"3\" cols=\"2\" data-name=\"aktuelle_medikamente_details\" ><\/textarea><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_9\" ><div class='ff-el-group vorerkrankung'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Do you have any relevant pre-existing conditions?\">Do you have any relevant pre-existing conditions?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='vorerkrankungen_01b31188734b57e7d01ec6979498fc5d'><input  type=\"checkbox\" name=\"vorerkrankungen[]\" data-name=\"vorerkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"diabetes_typ2\"  id='vorerkrankungen_01b31188734b57e7d01ec6979498fc5d' aria-label='Type 2 Diabetes Mellitus' aria-invalid='false' aria-required=true> <span>Type 2 Diabetes Mellitus<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='vorerkrankungen_01df2c6642d954dfdb7cce9971608ff9'><input  type=\"checkbox\" name=\"vorerkrankungen[]\" data-name=\"vorerkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"bluthochdruck\"  id='vorerkrankungen_01df2c6642d954dfdb7cce9971608ff9' aria-label='High Blood Pressure (Hypertension)' aria-invalid='false' aria-required=true> <span>High Blood Pressure (Hypertension)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='vorerkrankungen_5190b338bb1b1bfac2445902bb3a77eb'><input  type=\"checkbox\" name=\"vorerkrankungen[]\" data-name=\"vorerkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"herzerkrankung\"  id='vorerkrankungen_5190b338bb1b1bfac2445902bb3a77eb' aria-label='Heart Disease' aria-invalid='false' aria-required=true> <span>Heart Disease<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='vorerkrankungen_968aa48f3b985884b7357f41dfaaa6b2'><input  type=\"checkbox\" name=\"vorerkrankungen[]\" data-name=\"vorerkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"nierenerkrankung\"  id='vorerkrankungen_968aa48f3b985884b7357f41dfaaa6b2' aria-label='Kidney Diseases' aria-invalid='false' aria-required=true> <span>Kidney Diseases<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='vorerkrankungen_16c305e3b4f4432255a7718e256ba4cd'><input  type=\"checkbox\" name=\"vorerkrankungen[]\" data-name=\"vorerkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"keine\"  id='vorerkrankungen_16c305e3b4f4432255a7718e256ba4cd' aria-label='None of the listed pre-existing conditions' aria-invalid='false' aria-required=true> <span>None of the listed pre-existing conditions<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='vorerkrankungen_766daf1e1c7d16fc6beae2ae62aafc07'><input  type=\"checkbox\" name=\"vorerkrankungen[]\" data-name=\"vorerkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"andere\"  id='vorerkrankungen_766daf1e1c7d16fc6beae2ae62aafc07' aria-label='Other Pre-existing Conditions' aria-invalid='false' aria-required=true> <span>Other Pre-existing Conditions<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_vorerkrankungen_details' id='label_ff_4_vorerkrankungen_details' aria-label=\"Please describe any other pre-existing medical conditions you have:\">Please describe any other pre-existing medical conditions you have:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_4_vorerkrankungen_details\" name=\"vorerkrankungen_details\" id=\"ff_4_vorerkrankungen_details\" class=\"ff-el-form-control\" placeholder=\"Please describe your pre-existing conditions in more detail...\" rows=\"3\" cols=\"2\" data-name=\"vorerkrankungen_details\" ><\/textarea><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_10\" ><div class='ff-el-group begleiterkrankung'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Do you suffer from weight-related comorbidities?\">Do you suffer from weight-related comorbidities?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='begleiterkrankungen_e33c0b47c797c5f2013f46a8a5a6f07d'><input  type=\"checkbox\" name=\"begleiterkrankungen[]\" data-name=\"begleiterkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"schlafapnoe\"  id='begleiterkrankungen_e33c0b47c797c5f2013f46a8a5a6f07d' aria-label='Sleep Apnea' aria-invalid='false' aria-required=true> <span>Sleep Apnea<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='begleiterkrankungen_44818c4c1948d88a71df328dfe516827'><input  type=\"checkbox\" name=\"begleiterkrankungen[]\" data-name=\"begleiterkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"gelenkschmerzen\"  id='begleiterkrankungen_44818c4c1948d88a71df328dfe516827' aria-label='Chronic Joint Pain' aria-invalid='false' aria-required=true> <span>Chronic Joint Pain<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='begleiterkrankungen_8d45ff48e0aa66d1a6640b9d448a9220'><input  type=\"checkbox\" name=\"begleiterkrankungen[]\" data-name=\"begleiterkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"fettstoffwechsel\"  id='begleiterkrankungen_8d45ff48e0aa66d1a6640b9d448a9220' aria-label='Lipid Metabolism Disorder (Dyslipidemia)' aria-invalid='false' aria-required=true> <span>Lipid Metabolism Disorder (Dyslipidemia)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='begleiterkrankungen_c0b64f2b97ccf031a5f13f5b7473c919'><input  type=\"checkbox\" name=\"begleiterkrankungen[]\" data-name=\"begleiterkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"fettleber\"  id='begleiterkrankungen_c0b64f2b97ccf031a5f13f5b7473c919' aria-label='Fatty Liver' aria-invalid='false' aria-required=true> <span>Fatty Liver<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='begleiterkrankungen_415da3fc8d8c68c0cceb63088b1dd896'><input  type=\"checkbox\" name=\"begleiterkrankungen[]\" data-name=\"begleiterkrankungen\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"keine\"  id='begleiterkrankungen_415da3fc8d8c68c0cceb63088b1dd896' aria-label='No comorbidities' aria-invalid='false' aria-required=true> <span>No comorbidities<\/span><\/label><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_11\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Do you have any known allergies (especially to medications)?\">Do you have any known allergies (especially to medications)?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='allergien_status_d9041f2d368f896009f462f4abfe01cb'><input  type=\"radio\" name=\"allergien_status\" data-name=\"allergien_status\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"ja\"  id='allergien_status_d9041f2d368f896009f462f4abfe01cb' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='allergien_status_a7ca93c29869333388a16b245de3ecde'><input  type=\"radio\" name=\"allergien_status\" data-name=\"allergien_status\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"nein\"  id='allergien_status_a7ca93c29869333388a16b245de3ecde' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_allergien_details' id='label_ff_4_allergien_details' aria-label=\"Please list your allergies:\">Please list your allergies:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_4_allergien_details\" name=\"allergien_details\" id=\"ff_4_allergien_details\" class=\"ff-el-form-control\" placeholder=\"Please describe your allergies...\" rows=\"3\" cols=\"2\" data-name=\"allergien_details\" ><\/textarea><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_12\" ><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_herkunft' id='label_ff_4_herkunft' aria-label=\"How did you hear about NOVVA?\">How did you hear about NOVVA?<\/label><\/div><div class='ff-el-input--content'><select name=\"herkunft\" id=\"ff_4_herkunft\" class=\"ff-el-form-control\" data-name=\"herkunft\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_4_herkunft\"><option value=\"\">- Please select -<\/option><option value=\"social_media\"  >Social Media (Instagram, TikTok, etc.)<\/option><option value=\"google\"  >Google Search<\/option><option value=\"empfehlung\"  >Recommendations from friends\/family<\/option><option value=\"arzt\"  >Doctor \/ Medical Staff<\/option><option value=\"andere\"  >Others<\/option><\/select><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_herkunft_andere' id='label_ff_4_herkunft_andere' aria-label=\"How did you hear about us?\">How did you hear about us?<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"true\" aria-labelledby=\"label_ff_4_herkunft_andere\" name=\"herkunft_andere\" id=\"ff_4_herkunft_andere\" class=\"ff-el-form-control\" placeholder=\"Please let us know how you heard about us...\" rows=\"3\" cols=\"2\" data-name=\"herkunft_andere\" ><\/textarea><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\"result fluentform-step\" data-name=\"form_step-4_13\" ><div class='ff-el-group dontshow'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_numeric_field' id='label_ff_4_numeric_field' aria-label=\"BMI\">BMI<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric_field\" id=\"ff_4_numeric_field\" class=\"ff-el-form-control  ff_has_formula\" data-name=\"numeric_field\" data-calculation_formula=\"round({input.numeric_field_2}\/(({input.numeric_field_1}\/100)*({input.numeric_field_1}\/100)), 1)\" readonly=\"1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_14\" ><div class=\"novva-error\" style=\"display:none\">\n<h3>Unfortunately, treatment is not currently possible.<\/h3>\n<p>Your calculated BMI is below the minimum required for the NOVVA program.<\/p>\n<p>Treatment can only be provided if the medical requirements are met.<\/p>\n<\/div>\n<div class=\"novva-success\" style=\"display:none\">\n<h3>\u2713 Provisionally suitable<\/h3>\n<p>Based on the information you have provided so far, you meet the basic requirements for a medical examination.<\/p>\n<p>Please fill in your personal information so that our doctors can process your request.<\/p>\n<\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_15\" ><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_16\" ><p>Almost done! Please review your medical information and provide your contact details to complete the eligibility assessment. <\/p><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_first_name_' id='label_ff_4_names_first_name_' >First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_4_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"First Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_last_name_' id='label_ff_4_names_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_4_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Last Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_phone' id='label_ff_4_phone' aria-label=\"Phone number\">Phone number<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Phone number\" data-name=\"phone\" id=\"ff_4_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_email_1' id='label_ff_4_email_1' aria-label=\"Email address\">Email address<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_1\" id=\"ff_4_email_1\" class=\"ff-el-form-control\" placeholder=\"ihre.email@beispiel.de\" data-name=\"email_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--label'><label aria-label=\"Home Address\">Home Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_address_line_1_' id='label_ff_4_address_1_address_line_1_' aria-label=\"Street and House Number\">Street and House Number<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_4_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Street and House Number\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_city_' id='label_ff_4_address_1_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_4_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_zip_' id='label_ff_4_address_1_zip_' aria-label=\"ZIP Code\">ZIP Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_4_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"ZIP Code\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_country_' id='label_ff_4_address_1_country_' aria-label=\"Country\">Country<\/label><\/div><div class='ff-el-input--content'><select name=\"address_1[country]\" id=\"ff_4_address_1_country_\" class=\"ff-el-form-control\" placeholder=\"Select a country\" data-key_name=\"country\" aria-invalid='false' aria-required=true><option value=''>Select a country<\/option><option value='AT' >Austria<\/option><option value='DE' selected>Germany<\/option><option value='CH' >Switzerland<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group  myaccept  ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Terms and Conditions: I agree to NOVVA&#039;s Terms and Conditions, Telemedicine Policy, and Privacy Policy, and I consent to the processing of my medical data. Contains 3 links. Use tab navigation to review.' class='ff-el-form-check-label ff_tc_label' for='terms-n-condition_e6115aedead82d71048321c8fcd09250'><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition\" id=\"terms-n-condition_e6115aedead82d71048321c8fcd09250\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>I agree to NOVVA's <a href=\"https:\/\/www.mynovva.de\/en\/terms-and-conditions\/\" target=\"_blank\" rel=\"noopener\">Terms and Conditions<\/a>, <a href=\"https:\/\/www.mynovva.de\/en\/consent-to-telemedicine\/\" target=\"_blank\" rel=\"noopener\">Telemedicine<\/a> Policy, and <a href=\"https:\/\/www.mynovva.de\/en\/privacy-policy\/\" target=\"_blank\" rel=\"noopener\">Privacy Policy<\/a>, and I consent to the processing of my medical data.<\/p><\/div><\/label><\/div><\/div><div class='ff-el-group  myaccept  ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='I hereby confirm that I have provided the above information completely, accurately, and to the best of my knowledge and belief. I certify that this information is true and accurate.' class='ff-el-form-check-label ff_tc_label' for='terms-n-condition_1_a099c25b2f2517f1909bc01315ac49fa'><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition_1\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition_1\" id=\"terms-n-condition_1_a099c25b2f2517f1909bc01315ac49fa\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>I hereby confirm that I have provided the above information completely, accurately, and to the best of my knowledge and belief. I certify that this information is true and accurate. <\/p><\/div><\/label><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_17\" ><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_18\" ><div id=\"novva-review\"><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-4_19\" ><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-4_20\" ><p>Select a payment method.<\/p>\n<p>The fee for the initial medical examination for your NOVVA program is \u20ac99.90.<\/p>\n<p>Each <b>follow-up visit after 3 months<\/b> costs <b>\u20ac29.90.<\/b> Within the first three months <b>,<\/b> <b>an additional visit or a follow-up prescription<\/b> is <b>free of charge<\/b>. <\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Costs\">Costs  <\/label><\/div><div class='ff-el-input--content'><input type=\"hidden\" id=\"ff_4_payment_input\" name=\"payment_input\" value=\"99.90\" class=\"ff_payment_item\" data-payment_item=\"yes\" data-payment_value=\"99.90\" data-payment_label=\"Costs  \" ><span class=\"ff_item_price_wrapper\"><span class=\"ff_product_price_label\"><\/span> <span class=\"ff_product_price\">99,90\u20ac<\/span><\/span><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Payment Method\">Payment Method<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-payment-method-label'><label class='ff-el-form-check-label' for=payment_method_e21727fa31e53f43d5c133676c9693af><input name=\"payment_method\" type=\"radio\" data-name=\"payment_method\" class=\"ff-el-form-check-input ff_payment_method\" value=\"stripe\"  id='payment_method_e21727fa31e53f43d5c133676c9693af'> <span>Pay by credit card (Stripe)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-payment-method-label'><label class='ff-el-form-check-label' for=payment_method_9ac37cbe828336346eef47774d02fdea><input name=\"payment_method\" type=\"radio\" data-name=\"payment_method\" class=\"ff-el-form-check-input ff_payment_method\" value=\"paypal\"  id='payment_method_9ac37cbe828336346eef47774d02fdea'> <span>Pay with PayPal<\/span><\/label><\/div><div class=\"stripe-inline-wrapper ff_pay_inline ff_pay_inline_stripe\" style=\"display: none\"><div class=\"ff-el-input--label\"><label for=\"payment_method_4_1_stripe_inline\">Pay by credit card (Stripe)<\/label><\/div><div name=\"stripe_card_element\" class=\"ff_stripe_card_element ff-el-form-control\" data-wpf_payment_method=\"stripe\" id=\"payment_method_4_1_stripe_inline\" data-checkout_style=\"embedded_form\" ><\/div><div class=\"ff_card-errors text-danger\" role=\"alert\"><\/div><\/div><\/div><\/div>        <div class=\"ff-step-t-container ff-inner_submit_container ff-column-container ff_columns_total_2\">\n            <div class=\"ff-t-cell ff-t-column-1\"><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><\/div><\/div>\n            <div class=\"ff-t-cell ff-t-column-2\">\n                <div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\"  aria-label=\"Submit\">Submit<\/button><\/div>            <\/div>\n        <\/div>\n        <\/div><\/div><\/div>\n        <\/fieldset><\/form><div id='fluentform_4_errors' class='ff-errors-in-stack ff_form_instance_4_1 ff-form-loading_errors ff_form_instance_4_1_errors'><\/div><\/div>            <script type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_4_1 = 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