{"id":1148,"date":"2018-07-11T14:55:38","date_gmt":"2018-07-11T13:55:38","guid":{"rendered":"http:\/\/hosting1979.af915.netcup.net\/ini\/?page_id=1148"},"modified":"2021-03-19T15:07:22","modified_gmt":"2021-03-19T14:07:22","slug":"international-inquiry-portal","status":"publish","type":"page","link":"http:\/\/www.ini-hannover.de\/en\/international-inquiry-portal\/","title":{"rendered":"International Inquiry Portal"},"content":{"rendered":"<div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 hundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"background-color: rgba(255,255,255,0);background-position: center center;background-repeat: no-repeat;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;margin-bottom: 0px;margin-top: 0px;border-width: 0px 0px 0px 0px;border-color:#eae9e9;border-style:solid;\" ><div class=\"fusion-builder-row fusion-row\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-column-no-min-height\" style=\"margin-top:0px;margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><div class=\"fusion-text fusion-text-3\"><\/div>\n<div class=\"fusion-slider-revolution rev_slider_wrapper\">\t\t\t<!-- START Home REVOLUTION SLIDER 6.5.31 --><p class=\"rs-p-wp-fix\"><\/p>\n\t\t\t<rs-module-wrap id=\"rev_slider_1_2_wrapper\" data-source=\"gallery\" style=\"visibility:hidden;background:#FFFFFF;padding:0;margin:0px auto;margin-top:0;margin-bottom:0;\">\n\t\t\t\t<rs-module id=\"rev_slider_1_2\" style=\"\" data-version=\"6.5.31\">\n\t\t\t\t\t<rs-slides>\n\t\t\t\t\t\t<rs-slide style=\"position: absolute;\" data-key=\"rs-3\" data-title=\"Slide\" data-anim=\"d:50;f:edges;\" data-in=\"prst:rndany;o:-0.5;x:(15%);sx:0.8;sy:0.8;row:5;col:5;\" data-d3=\"f:cube;z:450;t:20;su:true;sc:#9e9e9e;\">\n\t\t\t\t\t\t\t<img src=\"\/\/www.ini-hannover.de\/wp-content\/plugins\/revslider\/public\/assets\/assets\/dummy.png\" alt=\"\" title=\"International Inquiry Portal\" class=\"rev-slidebg tp-rs-img rs-lazyload\" data-lazyload=\"\/\/www.ini-hannover.de\/wp-content\/uploads\/2015\/07\/INI-Geb\u00e4ude.png\" data-bg=\"p:center bottom;\" data-no-retina>\n<!---->\t\t\t\t\t\t<\/rs-slide>\n\t\t\t\t\t\t<rs-slide style=\"position: absolute;\" data-key=\"rs-4\" data-title=\"Slide\" data-in=\"o:0;\" data-out=\"a:false;\">\n\t\t\t\t\t\t\t<img src=\"\/\/www.ini-hannover.de\/wp-content\/plugins\/revslider\/public\/assets\/assets\/dummy.png\" alt=\"Slide\" title=\"International Inquiry Portal\" class=\"rev-slidebg tp-rs-img rs-lazyload\" data-lazyload=\"\/\/www.ini-hannover.de\/wp-content\/plugins\/revslider\/public\/assets\/assets\/transparent.png\" data-no-retina>\n<!---->\t\t\t\t\t\t<\/rs-slide>\n\t\t\t\t\t<\/rs-slides>\n\t\t\t\t<\/rs-module>\n\t\t\t\t<script>\n\t\t\t\t\tsetREVStartSize({c: 'rev_slider_1_2',rl:[1240,1024,778,480],el:[],gw:[960],gh:[450],type:'standard',justify:'',layout:'fullwidth',mh:\"450\"});if (window.RS_MODULES!==undefined && window.RS_MODULES.modules!==undefined && window.RS_MODULES.modules[\"revslider12\"]!==undefined) {window.RS_MODULES.modules[\"revslider12\"].once = false;window.revapi1_2 = undefined;if (window.RS_MODULES.checkMinimal!==undefined) window.RS_MODULES.checkMinimal()}\n\t\t\t\t<\/script>\n\t\t\t<\/rs-module-wrap>\n\t\t\t<!-- END REVOLUTION SLIDER -->\n<\/div><div class=\"fusion-layout-column fusion_builder_column_inner fusion-builder-nested-column-1 fusion_builder_column_inner_1_3 1_3 fusion-one-third\" style=\"width:30.6666%; margin-right: 4%;margin-top:0px;margin-bottom:20px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;background-color:#ffffff;padding: 0px 0px 0px 0px;\"><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_1 1_1 fusion-one-full fusion-column-first fusion-column-last fusion-column-no-min-height\" style=\"margin-top:0px;margin-bottom:0px;\"><div class=\"fusion-column-wrapper fusion-flex-column-wrapper-legacy\" style=\"background-position:left top;background-repeat:no-repeat;-webkit-background-size:cover;-moz-background-size:cover;-o-background-size:cover;background-size:cover;padding: 0px 0px 0px 0px;\"><style type=\"text\/css\"><\/style><div class=\"fusion-title title fusion-title-2 fusion-title-text fusion-title-size-three\" style=\"margin-top:0px;margin-right:0px;margin-bottom:31px;margin-left:0px;\"><h3 class=\"title-heading-left fusion-responsive-typography-calculated\" style=\"margin:0;--fontSize:16;--minFontSize:16px;line-height:1.5;\"><strong><span style=\"color: #333333;\">International <\/span>Inquiry Portal &#8211; Transfer of Patient Data<\/strong><\/h3><span class=\"awb-title-spacer\"><\/span><div class=\"title-sep-container\"><div class=\"title-sep sep-single sep-solid\" style=\"border-color:#e0dede;\"><\/div><\/div><\/div><div class=\"fusion-text fusion-text-4\"><\/div><div class=\"su-row\"> <div class=\"su-column su-column-size-2-3\"><div class=\"su-column-inner su-u-clearfix su-u-trim\">\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f886-o2\" lang=\"de-DE\" dir=\"ltr\">\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\/1148#wpcf7-f886-o2\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Kontaktformular\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"886\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.7.4\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"de_DE\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f886-o2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div id=\"responsive-form\" class=\"clearfix\">\n\t<div class=\"column-full\">\n\t\t<p>Dear patient,\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column-full\">\n\t\t<p>we would like to thank you for your inquiry and the transmission of your data.\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column-full\">\n\t\t<p>Documents in German and English are accepted.\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p>The assessment of your inquiry includes the medical analysis of all provided medical documents (CT, MRI, PET, X-ray, angiography etc.), the neurophysiological documents (EEG, EMG etc.) and the final assessment and recommendation.\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>The evaluation as well as the preparation of the professional statement including the medical recommendation is subject to a prior fee of EUR*300,00. <strong>The answer to your inquiry and the receipt of the fee will be made on behalf of Prof. Dr. Dr. Madjid Samii.<\/strong>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Once you have entered your information, you will receive an email requesting you to pay the amount of EUR*300.\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>If you do not consent, you can go back to the homepage <a href=\"https:\/\/www.ini-hannover.de\/en\"><strong>\n\t\t\t\t\t\t<font color= \"67b7e1\">here\n\t\t\t\t\t\t<\/font><\/strong><\/a>.\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>\n\t\t\t\t<font color=\"red\">\n\t\t\t\t\t<font size= \"5\"><strong>*<\/strong>\n\t\t\t\t\t<\/font>\n\t\t\t\t<\/font>\n\t\t\t\t<font color=\"red\"><strong>This is a required field in the form, please fill out.<\/strong>\n\t\t\t\t<\/font>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Patient first name\n\t\t\t\t<font color=\"red\">\n\t\t\t\t\t<font size= \"5\"><strong>*<\/strong>\n\t\t\t\t\t<\/font>\n\t\t\t\t<\/font><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patientvorname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patientvorname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Patient family name\n\t\t\t\t<font color=\"red\">\n\t\t\t\t\t<font size= \"5\"><strong>*<\/strong>\n\t\t\t\t\t<\/font>\n\t\t\t\t<\/font><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"patientnachname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"patientnachname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-half\">\n\t\t\t<p style=\"margin-bottom: 0px;\">DOB\n\t\t\t\t<font color=\"red\">\n\t\t\t\t\t<font size= \"5\"><strong>*<\/strong>\n\t\t\t\t\t<\/font>\n\t\t\t\t<\/font><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"birthday\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"birthday\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Gender\n\t\t\t\t<font color=\"red\">\n\t\t\t\t\t<font size= \"5\"><strong>*<\/strong>\n\t\t\t\t\t<\/font>\n\t\t\t\t<\/font><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"gender\"><option value=\"\">&#8211; Bitte ausw\u00e4hlen &#8211;<\/option><option value=\"Male\">Male<\/option><option value=\"Female\">Female<\/option><option value=\"Transgender\">Transgender<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-half\">\n\t\t\t<p>Citizenship\n\t\t\t\t<font color=\"red\">\n\t\t\t\t\t<font size= \"5\"><strong>*<\/strong>\n\t\t\t\t\t<\/font>\n\t\t\t\t<\/font><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"countrylist\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"countrylist\"><option value=\"\">&#8211; Bitte ausw\u00e4hlen &#8211;<\/option><option value=\"Afghanistan\">Afghanistan<\/option><option value=\"Albania\">Albania<\/option><option value=\"Algeria\">Algeria<\/option><option value=\"American Samoa\">American Samoa<\/option><option value=\"Andorra\">Andorra<\/option><option value=\"Angola\">Angola<\/option><option value=\"Anguilla\">Anguilla<\/option><option value=\"Antarctica\">Antarctica<\/option><option value=\"Antigua and Barbuda\">Antigua and Barbuda<\/option><option value=\"Argentina\">Argentina<\/option><option value=\"Armenia\">Armenia<\/option><option value=\"Arctic Ocean\">Arctic Ocean<\/option><option value=\"Aruba\">Aruba<\/option><option value=\"Ashmore and Cartier Islands\">Ashmore and Cartier Islands<\/option><option value=\"Atlantic Ocean\">Atlantic Ocean<\/option><option value=\"Australia\">Australia<\/option><option value=\"Austria\">Austria<\/option><option value=\"Azerbaijan\">Azerbaijan<\/option><option value=\"Bahamas\">Bahamas<\/option><option value=\"Bahrain\">Bahrain<\/option><option value=\"Baker Island\">Baker Island<\/option><option value=\"Bangladesh\">Bangladesh<\/option><option value=\"Barbados\">Barbados<\/option><option value=\"Bassas da India\">Bassas da India<\/option><option value=\"Belarus\">Belarus<\/option><option value=\"Belgium\">Belgium<\/option><option value=\"Belize\">Belize<\/option><option value=\"Benin\">Benin<\/option><option value=\"Bermuda\">Bermuda<\/option><option value=\"Bhutan\">Bhutan<\/option><option value=\"Bolivia\">Bolivia<\/option><option value=\"Bosnia and Herzegovina\">Bosnia and Herzegovina<\/option><option value=\"Botswana\">Botswana<\/option><option value=\"Bouvet Island\">Bouvet Island<\/option><option value=\"Brazil\">Brazil<\/option><option value=\"British Virgin Islands\">British Virgin Islands<\/option><option value=\"Brunei\">Brunei<\/option><option value=\"Bulgaria\">Bulgaria<\/option><option value=\"Burkina Faso\">Burkina Faso<\/option><option value=\"Burundi\">Burundi<\/option><option value=\"Cambodia\">Cambodia<\/option><option value=\"Cameroon\">Cameroon<\/option><option value=\"Canada\">Canada<\/option><option value=\"Cape Verde\">Cape Verde<\/option><option value=\"Cayman Islands\">Cayman Islands<\/option><option value=\"Central African Republic\">Central African Republic<\/option><option value=\"Chad\">Chad<\/option><option value=\"Chile\">Chile<\/option><option value=\"China\">China<\/option><option value=\"Christmas Island\">Christmas Island<\/option><option value=\"Clipperton Island\">Clipperton Island<\/option><option value=\"Cocos Islands\">Cocos Islands<\/option><option value=\"Colombia\">Colombia<\/option><option value=\"Comoros\">Comoros<\/option><option value=\"Cook Islands\">Cook Islands<\/option><option value=\"Coral Sea Islands\">Coral Sea Islands<\/option><option value=\"Costa Rica\">Costa Rica<\/option><option value=\"Cote d&#039;Ivoire\">Cote d&#039;Ivoire<\/option><option value=\"Croatia\">Croatia<\/option><option value=\"Cuba\">Cuba<\/option><option value=\"Cyprus\">Cyprus<\/option><option value=\"Czech Republic\">Czech Republic<\/option><option value=\"Denmark\">Denmark<\/option><option value=\"Democratic Republic of the Congo\">Democratic Republic of the Congo<\/option><option value=\"Djibouti\">Djibouti<\/option><option value=\"Dominica\">Dominica<\/option><option value=\"Dominican Republic\">Dominican Republic<\/option><option value=\"East Timor\">East Timor<\/option><option value=\"Ecuador\">Ecuador<\/option><option value=\"Egypt\">Egypt<\/option><option value=\"El Salvador\">El Salvador<\/option><option value=\"Equatorial Guinea\">Equatorial Guinea<\/option><option value=\"Eritrea\">Eritrea<\/option><option value=\"Estonia\">Estonia<\/option><option value=\"Ethiopia\">Ethiopia<\/option><option value=\"Europa Island\">Europa Island<\/option><option value=\"Falkland Islands (Islas Malvinas)\">Falkland Islands (Islas Malvinas)<\/option><option value=\"Faroe Islands\">Faroe Islands<\/option><option value=\"Fiji\">Fiji<\/option><option value=\"Finland\">Finland<\/option><option value=\"France\">France<\/option><option value=\"French Guiana\">French Guiana<\/option><option value=\"French Polynesia\">French Polynesia<\/option><option value=\"French Southern and Antarctic Lands\">French Southern and Antarctic Lands<\/option><option value=\"Gabon\">Gabon<\/option><option value=\"Gambia\">Gambia<\/option><option value=\"Gaza Strip\">Gaza Strip<\/option><option value=\"Georgia\">Georgia<\/option><option value=\"Germany\">Germany<\/option><option value=\"Ghana\">Ghana<\/option><option value=\"Gibraltar\">Gibraltar<\/option><option value=\"Glorioso Islands\">Glorioso Islands<\/option><option value=\"Greece\">Greece<\/option><option value=\"Greenland\">Greenland<\/option><option value=\"Grenada\">Grenada<\/option><option value=\"Guadeloupe\">Guadeloupe<\/option><option value=\"Guam\">Guam<\/option><option value=\"Guatemala\">Guatemala<\/option><option value=\"Guernsey\">Guernsey<\/option><option value=\"Guinea\">Guinea<\/option><option value=\"Guinea-Bissau\">Guinea-Bissau<\/option><option value=\"Guyana\">Guyana<\/option><option value=\"Haiti\">Haiti<\/option><option value=\"Heard Island and McDonald Islands\">Heard Island and McDonald Islands<\/option><option value=\"Honduras\">Honduras<\/option><option value=\"Hong Kong\">Hong Kong<\/option><option value=\"Howland Island\">Howland Island<\/option><option value=\"Hungary\">Hungary<\/option><option value=\"Iceland\">Iceland<\/option><option value=\"India\">India<\/option><option value=\"Indian Ocean\">Indian Ocean<\/option><option value=\"Indonesia\">Indonesia<\/option><option value=\"Iran\">Iran<\/option><option value=\"Iraq\">Iraq<\/option><option value=\"Ireland\">Ireland<\/option><option value=\"Isle of Man\">Isle of Man<\/option><option value=\"Israel\">Israel<\/option><option value=\"Italy\">Italy<\/option><option value=\"Jamaica\">Jamaica<\/option><option value=\"Jan Mayen\">Jan Mayen<\/option><option value=\"Japan\">Japan<\/option><option value=\"Jarvis Island\">Jarvis Island<\/option><option value=\"Jersey\">Jersey<\/option><option value=\"Johnston Atoll\">Johnston Atoll<\/option><option value=\"Jordan\">Jordan<\/option><option value=\"Juan de Nova Island\">Juan de Nova Island<\/option><option value=\"Kazakhstan\">Kazakhstan<\/option><option value=\"Kenya\">Kenya<\/option><option value=\"Kingman Reef\">Kingman Reef<\/option><option value=\"Kiribati\">Kiribati<\/option><option value=\"Kerguelen Archipelago\">Kerguelen Archipelago<\/option><option value=\"Kosovo\">Kosovo<\/option><option value=\"Kuwait\">Kuwait<\/option><option value=\"Kyrgyzstan\">Kyrgyzstan<\/option><option value=\"Laos\">Laos<\/option><option value=\"Latvia\">Latvia<\/option><option value=\"Lebanon\">Lebanon<\/option><option value=\"Lesotho\">Lesotho<\/option><option value=\"Liberia\">Liberia<\/option><option value=\"Libya\">Libya<\/option><option value=\"Liechtenstein\">Liechtenstein<\/option><option value=\"Lithuania\">Lithuania<\/option><option value=\"Luxembourg\">Luxembourg<\/option><option value=\"Macau\">Macau<\/option><option value=\"Macedonia\">Macedonia<\/option><option value=\"Madagascar\">Madagascar<\/option><option value=\"Malawi\">Malawi<\/option><option value=\"Malaysia\">Malaysia<\/option><option value=\"Maldives\">Maldives<\/option><option value=\"Mali\">Mali<\/option><option value=\"Malta\">Malta<\/option><option value=\"Marshall Islands\">Marshall Islands<\/option><option value=\"Martinique\">Martinique<\/option><option value=\"Mauritania\">Mauritania<\/option><option value=\"Mauritius\">Mauritius<\/option><option value=\"Mayotte\">Mayotte<\/option><option value=\"Mexico\">Mexico<\/option><option value=\"Micronesia\">Micronesia<\/option><option value=\"Midway Islands\">Midway Islands<\/option><option value=\"Moldova\">Moldova<\/option><option value=\"Monaco\">Monaco<\/option><option value=\"Mongolia\">Mongolia<\/option><option value=\"Montenegro\">Montenegro<\/option><option value=\"Montserrat\">Montserrat<\/option><option value=\"Morocco\">Morocco<\/option><option value=\"Mozambique\">Mozambique<\/option><option value=\"Myanmar\">Myanmar<\/option><option value=\"Namibia\">Namibia<\/option><option value=\"Nauru\">Nauru<\/option><option value=\"Navassa Island\">Navassa Island<\/option><option value=\"Nepal\">Nepal<\/option><option value=\"Netherlands\">Netherlands<\/option><option value=\"Netherlands Antilles\">Netherlands Antilles<\/option><option value=\"New Caledonia\">New Caledonia<\/option><option value=\"New Zealand\">New Zealand<\/option><option value=\"Nicaragua\">Nicaragua<\/option><option value=\"Niger\">Niger<\/option><option value=\"Nigeria\">Nigeria<\/option><option value=\"Niue\">Niue<\/option><option value=\"Norfolk Island\">Norfolk Island<\/option><option value=\"North Korea\">North Korea<\/option><option value=\"North Sea\">North Sea<\/option><option value=\"Northern Mariana Islands\">Northern Mariana Islands<\/option><option value=\"Norway\">Norway<\/option><option value=\"Oman\">Oman<\/option><option value=\"Pacific Ocean\">Pacific Ocean<\/option><option value=\"Pakistan\">Pakistan<\/option><option value=\"Palau\">Palau<\/option><option value=\"Palmyra Atoll\">Palmyra Atoll<\/option><option value=\"Panama\">Panama<\/option><option value=\"Papua New Guinea\">Papua New Guinea<\/option><option value=\"Paracel Islands\">Paracel Islands<\/option><option value=\"Paraguay\">Paraguay<\/option><option value=\"Peru\">Peru<\/option><option value=\"Philippines\">Philippines<\/option><option value=\"Pitcairn Islands\">Pitcairn Islands<\/option><option value=\"Poland\">Poland<\/option><option value=\"Portugal\">Portugal<\/option><option value=\"Puerto Rico\">Puerto Rico<\/option><option value=\"Qatar\">Qatar<\/option><option value=\"Reunion\">Reunion<\/option><option value=\"Republic of the Congo\">Republic of the Congo<\/option><option value=\"Romania\">Romania<\/option><option value=\"Russia\">Russia<\/option><option value=\"Rwanda\">Rwanda<\/option><option value=\"Saint Helena\">Saint Helena<\/option><option value=\"Saint Kitts and Nevis\">Saint Kitts and Nevis<\/option><option value=\"Saint Lucia\">Saint Lucia<\/option><option value=\"Saint Pierre and Miquelon\">Saint Pierre and Miquelon<\/option><option value=\"Saint Vincent and the Grenadines\">Saint Vincent and the Grenadines<\/option><option value=\"Samoa\">Samoa<\/option><option value=\"San Marino\">San Marino<\/option><option value=\"Sao Tome and Principe\">Sao Tome and Principe<\/option><option value=\"Saudi Arabia\">Saudi Arabia<\/option><option value=\"Senegal\">Senegal<\/option><option value=\"Serbia\">Serbia<\/option><option value=\"Seychelles\">Seychelles<\/option><option value=\"Sierra Leone\">Sierra Leone<\/option><option value=\"Singapore\">Singapore<\/option><option value=\"Slovakia\">Slovakia<\/option><option value=\"Slovenia\">Slovenia<\/option><option value=\"Solomon Islands\">Solomon Islands<\/option><option value=\"Somalia\">Somalia<\/option><option value=\"South Africa\">South Africa<\/option><option value=\"South Georgia and the South Sandwich Islands\">South Georgia and the South Sandwich Islands<\/option><option value=\"South Korea\">South Korea<\/option><option value=\"Spain\">Spain<\/option><option value=\"Spratly Islands\">Spratly Islands<\/option><option value=\"Sri Lanka\">Sri Lanka<\/option><option value=\"Sudan\">Sudan<\/option><option value=\"Suriname\">Suriname<\/option><option value=\"Svalbard\">Svalbard<\/option><option value=\"Swaziland\">Swaziland<\/option><option value=\"Sweden\">Sweden<\/option><option value=\"Switzerland\">Switzerland<\/option><option value=\"Syria\">Syria<\/option><option value=\"Taiwan\">Taiwan<\/option><option value=\"Tajikistan\">Tajikistan<\/option><option value=\"Tanzania\">Tanzania<\/option><option value=\"Thailand\">Thailand<\/option><option value=\"Togo\">Togo<\/option><option value=\"Tokelau\">Tokelau<\/option><option value=\"Tonga\">Tonga<\/option><option value=\"Trinidad and Tobago\">Trinidad and Tobago<\/option><option value=\"Tromelin Island\">Tromelin Island<\/option><option value=\"Tunisia\">Tunisia<\/option><option value=\"Turkey\">Turkey<\/option><option value=\"Turkmenistan\">Turkmenistan<\/option><option value=\"Turks and Caicos Islands\">Turks and Caicos Islands<\/option><option value=\"Tuvalu\">Tuvalu<\/option><option value=\"Uganda\">Uganda<\/option><option value=\"Ukraine\">Ukraine<\/option><option value=\"United Arab Emirates\">United Arab Emirates<\/option><option value=\"United Kingdom\">United Kingdom<\/option><option value=\"USA\">USA<\/option><option value=\"Uruguay\">Uruguay<\/option><option value=\"Uzbekistan\">Uzbekistan<\/option><option value=\"Vanuatu\">Vanuatu<\/option><option value=\"Venezuela\">Venezuela<\/option><option value=\"Viet Nam\">Viet Nam<\/option><option value=\"Virgin Islands\">Virgin Islands<\/option><option value=\"Wake Island\">Wake Island<\/option><option value=\"Wallis and Futuna\">Wallis and Futuna<\/option><option value=\"West Bank\">West Bank<\/option><option value=\"Western Sahara\">Western Sahara<\/option><option value=\"Yemen\">Yemen<\/option><option value=\"Yugoslavia\">Yugoslavia<\/option><option value=\"Zambia\">Zambia<\/option><option value=\"Zimbabwe\">Zimbabwe<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Curent residence\n\t\t\t\t<font color=\"red\">\n\t\t\t\t\t<font size= \"5\"><strong>*<\/strong>\n\t\t\t\t\t<\/font>\n\t\t\t\t<\/font><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"wohnort\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"ZIP code, city, country...\" value=\"\" type=\"text\" name=\"wohnort\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-full\">\n\t\t\t<p>Patient email address\n\t\t\t\t<font color=\"red\">\n\t\t\t\t\t<font size= \"5\"><strong>*<\/strong>\n\t\t\t\t\t<\/font>\n\t\t\t\t<\/font><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-half\">\n\t\t\t<p>Contact person<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"kontaktperson\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"kontaktperson\"><option value=\"\">&#8211; Bitte ausw\u00e4hlen &#8211;<\/option><option value=\"Mediating doctor\">Mediating doctor<\/option><option value=\"Relative\">Relative<\/option><option value=\"Acquaintance\">Acquaintance<\/option><\/select><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Contact person given name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"kontaktvorname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"kontaktvorname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Contact person last name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"kontaktnachname\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"kontaktnachname\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>Contact person email address<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"contact-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-email\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"contact-email\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"column-full\">\n\t\t<p>We require the following medical information:\n\t\t<\/p>\n\t<\/div>\n\t<ul>\n\t\t<li>\n\t\t\t<p>MRI and\/or CT images on a CD\n\t\t\t<\/p>\n\t\t<\/li>\n\t\t<li>\n\t\t\t<p>Complete, current medical finding report:\n\t\t\t<\/p>\n\t\t\t<ul>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Neurosurgical findings\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Physician letters\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Surgery reports\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t\t<li>\n\t\t\t\t\t<p>Evaluation of the neurological state with state of consciousness, Cardiopulmonary state, statement of a possibly existing comatose state\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/li>\n\t\t\t<\/ul>\n\t\t<\/li>\n\t<\/ul>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Please fill in further information as free text into this field...\" name=\"your-message\"><\/textarea><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<p><span id=\"wpcf7-69f4829872a33-wrapper\" class=\"wpcf7-form-control-wrap email-wrap\" style=\"display:none !important; visibility:hidden !important;\"><label for=\"wpcf7-69f4829872a33-field\" class=\"hp-message\">Please leave this field empty.<\/label><input id=\"wpcf7-69f4829872a33-field\"  class=\"wpcf7-form-control wpcf7-text\" type=\"text\" name=\"email\" value=\"\" size=\"40\" tabindex=\"-1\" autocomplete=\"new-password\" \/><\/span>\n\t<\/p>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-full\">\n\t\t\t<p class=\"hide\">Documents<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"daten1\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"daten1\" \/><\/span>\n\t\t\t<\/p>\n\t\t\t<p class=\"hide\"><span class=\"wpcf7-form-control-wrap\" data-name=\"daten2\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"daten2\" \/><\/span><a class=\"del_file\" href=\"#\"> <i class=\"fa fa-trash-o fa-2x\"><\/i><br \/>\n<\/a>\n\t\t\t<\/p>\n\t\t\t<p class=\"hide\"><span class=\"wpcf7-form-control-wrap\" data-name=\"daten3\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-file\" accept=\"audio\/*,video\/*,image\/*\" aria-invalid=\"false\" type=\"file\" name=\"daten3\" \/><\/span><a class=\"del_file\" href=\"#\"> <i class=\"fa fa-trash-o fa-2x\"><\/i><br \/>\n<\/a>\n\t\t\t<\/p>\n\t\t\t<p><a href=\"#\" class=\"add_file\"><i class=\"fa fa-plus fa-lg\"><\/i> add file<\/a>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"form-row\">\n\t\t<div class=\"column-half\">\n\t\t\t<p>Graphic formats:\n\t\t\t<\/p>\n\t\t\t<p>Text formats:\n\t\t\t<\/p>\n\t\t\t<p>Compressed files:\n\t\t\t<\/p>\n\t\t\t<p>Dicom files:\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"column-half\">\n\t\t\t<p>.jpeg, .jpg, .png\n\t\t\t<\/p>\n\t\t\t<p>.pdf, .docx, .doc\n\t\t\t<\/p>\n\t\t\t<p>.rar, .zip\n\t\t\t<\/p>\n\t\t\t<p>.ima, .img, .dcm\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n\t<div class=\"column-full\">\n\t\t<p>Note: Documents in German and English are accepted. You can upload a total of three attachements with a maximum size of 5MB. Please do not send links since we do not open them due to safety reasons.\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column-full\">\n\t\t<p>We would like to point out that a misuse by third parties during the transfer of medical data via the internet cannot be exempt. However, once received by the INI - International Neuroscience Institute\u00ae Hanover the data underlies medical confidentiality.\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"column-full\">\n\t\t<p><input class=\"wpcf7-form-control has-spinner wpcf7-submit\" type=\"submit\" value=\"send\" \/>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<!--end responsive-form--><div class=\"fusion-alert alert custom alert-custom fusion-alert-center wpcf7-response-output alert-dismissable\" role=\"alert\" style=\"border-width:1px;\"><div class=\"fusion-alert-content-wrapper\"><span class=\"fusion-alert-content\"><\/span><\/div><button type=\"button\" class=\"close toggle-alert\" data-dismiss=\"alert\" aria-label=\"Close\">&times;<\/button><\/div>\n<\/form>\n<\/div>\n\n<\/div><\/div> <div class=\"su-column su-column-size-1-3\"><div class=\"su-column-inner su-u-clearfix su-u-trim\"><\/div><\/div><\/div><div class=\"fusion-clearfix\"><\/div><\/div><\/div><\/div><style type=\"text\/css\">.fusion-fullwidth.fusion-builder-row-1 { overflow:visible; }<\/style><\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.1 - 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