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Neem Vrijblijvend Contact op met VKG Zorg. We reageren altijd binnen 24 uur!
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<html lang="nl">
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<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>VKG Zorg - Contactformulier</title>
<link rel="preconnect" href="https://fonts.googleapis.com">
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
<link href="https://fonts.googleapis.com/css2?family=DM+Sans:wght@400;500;600;700&display=swap" rel="stylesheet">
<style>
/* VKG Zorg huisstijl */
:root {
--primary-color: #1e3a5f; /* Donkerblauw */
--secondary-color: #7ecadf; /* Lichtblauw/turquoise */
--accent-color: #e94e4e; /* Rood */
--text-color: #333333;
--light-bg: #ffffff;
--light-gray: #f5f7fa;
--border-radius: 8px;
--box-shadow: 0 4px 12px rgba(0, 0, 0, 0.08);
--transition: all 0.3s ease;
}
* {
margin: 0;
padding: 0;
box-sizing: border-box;
}
body {
font-family: 'DM Sans', sans-serif;
color: var(--text-color);
line-height: 1.6;
background-color: var(--light-bg);
}
.form-container {
max-width: 800px;
margin: 0 auto;
padding: 20px;
}
.form-header {
text-align: center;
margin-bottom: 30px;
}
.form-header img {
max-width: 180px;
margin-bottom: 20px;
}
.form-header h1 {
font-size: 28px;
font-weight: 700;
color: var(--primary-color);
margin-bottom: 10px;
}
.form-header p {
font-size: 16px;
color: var(--text-color);
max-width: 600px;
margin: 0 auto;
}
.form-wrapper {
background-color: var(--primary-color);
border-radius: var(--border-radius);
padding: 30px 0;
box-shadow: var(--box-shadow);
overflow: hidden;
}
.form-title {
color: white;
font-size: 24px;
font-weight: 600;
text-align: center;
margin-bottom: 20px;
}
.form-inner {
background-color: white;
border-radius: var(--border-radius);
padding: 30px;
margin: 0 30px;
}
.form-logo {
display: flex;
justify-content: center;
margin-bottom: 20px;
}
.form-logo img {
max-width: 150px;
}
/* Zoho Form Styling */
#crmWebToEntityForm {
width: 100%;
max-width: 100%;
padding: 0;
margin: 0;
background-color: transparent;
color: var(--text-color);
}
.zcwf_row {
margin: 15px 0;
display: flex;
flex-wrap: wrap;
}
.zcwf_col_lab, .zcwf_col_fld {
padding: 6px 0;
}
.zcwf_col_lab {
width: 30%;
font-size: 16px;
font-weight: 500;
color: var(--primary-color);
padding-right: 15px;
}
.zcwf_col_fld {
width: 70%;
position: relative;
}
.zcwf_col_fld input[type=text],
.zcwf_col_fld input[type=email],
.zcwf_col_fld textarea {
width: 100%;
padding: 12px 15px;
border: 1px solid #ddd;
border-radius: var(--border-radius);
font-family: 'DM Sans', sans-serif;
font-size: 15px;
transition: var(--transition);
}
.zcwf_col_fld input[type=text]:focus,
.zcwf_col_fld input[type=email]:focus,
.zcwf_col_fld textarea:focus {
outline: none;
border-color: var(--secondary-color);
box-shadow: 0 0 0 2px rgba(126, 202, 223, 0.2);
}
.zcwf_col_help {
font-size: 13px;
color: #666;
margin-top: 4px;
}
/* Submit button styling based on the provided example */
.formsubmit {
background-color: var(--accent-color) !important;
color: white !important;
font-weight: 600 !important;
font-size: 16px !important;
padding: 12px 30px !important;
border: none !important;
border-radius: 50px !important; /* Rounded corners as in example */
cursor: pointer !important;
transition: var(--transition) !important;
max-width: none !important;
text-transform: none !important;
box-shadow: none !important;
display: inline-block !important;
text-align: center !important;
}
.formsubmit:hover {
background-color: #d83c3c !important;
transform: translateY(-2px);
}
/* Reset button styling based on the provided example */
input[type=reset].zcwf_button {
background-color: transparent !important;
color: var(--primary-color) !important;
border: 1px solid var(--primary-color) !important;
font-weight: 600 !important;
font-size: 16px !important;
padding: 12px 30px !important;
border-radius: 50px !important; /* Rounded corners as in example */
cursor: pointer !important;
transition: var(--transition) !important;
max-width: none !important;
margin-left: 10px;
display: inline-block !important;
text-align: center !important;
}
input[type=reset].zcwf_button:hover {
background-color: #f5f7fa !important;
}
.zcwf_button {
font-family: 'DM Sans', sans-serif !important;
}
.required-mark {
color: var(--accent-color);
margin-left: 3px;
}
.form-footer {
text-align: center;
margin-top: 30px;
font-size: 14px;
color: #666;
}
.form-footer p {
margin-bottom: 10px;
}
.response-time {
display: flex;
align-items: center;
justify-content: center;
margin-top: 20px;
padding: 15px;
background-color: var(--light-gray);
border-radius: var(--border-radius);
}
.response-time svg {
margin-right: 10px;
color: var(--accent-color);
}
.response-time p {
font-size: 15px;
margin: 0;
}
.response-time strong {
color: var(--primary-color);
}
/* Responsive Styling */
@media (max-width: 768px) {
.zcwf_col_lab, .zcwf_col_fld {
width: 100%;
padding: 3px 0;
}
.form-inner {
padding: 20px;
margin: 0 15px;
}
.form-wrapper {
padding: 20px 0;
}
.zcwf_row {
margin: 10px 0;
}
}
</style>
</head>
<body>
<div class="form-container">
<div class="form-wrapper">
<h2 class="form-title">Contactformulier</h2>
<div class="form-inner">
<div class="form-logo">
<img src="https://vkg-zorg.nl/wp-content/uploads/2025/02/VKG-Zorg-logo-email.svg" alt="VKG Zorg Logo">
</div>
<!-- Zoho CRM Web-to-Lead Form -->
<div id='crmWebToEntityForm' class='zcwf_lblLeft'>
<form id='webform744964000001446306' action='https://crm.zoho.eu/crm/WebToLeadForm' name='WebToLeads744964000001446306' method='POST' onSubmit='javascript:document.charset="UTF-8"; return checkMandatory744964000001446306()' accept-charset='UTF-8'>
<input type='text' style='display:none;' name='xnQsjsdp' value='3c559b8384f62f8cee71584675dade022a02a3401f776b541e649ddfbf0b612b'></input>
<input type='hidden' name='zc_gad' id='zc_gad' value=''></input>
<input type='text' style='display:none;' name='xmIwtLD' value='4c1f80697f13d1cfe82c16b8eb0396c84bdef9193cdfea39be4bd7813b6a1d56534f3da2dee6a1d8ff2ba5bd91a9c2d3'></input>
<input type='text' style='display:none;' name='actionType' value='TGVhZHM='></input>
<input type='text' style='display:none;' name='returnURL' value='null'></input>
<!-- Do not remove this code. -->
<input type='text' style='display:none;' id='ldeskuid' name='ldeskuid'></input>
<input type='text' style='display:none;' id='LDTuvid' name='LDTuvid'></input>
<!-- Do not remove this code. -->
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='First_Name'>Voornaam</label>
</div>
<div class='zcwf_col_fld'>
<input type='text' id='First_Name' name='First Name' maxlength='40'>
</input>
</div>
</div>
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Last_Name'>Achternaam<span class="required-mark">*</span></label>
</div>
<div class='zcwf_col_fld'>
<input type='text' id='Last_Name' name='Last Name' maxlength='80'>
</input>
</div>
</div>
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Company'>Bedrijf<span class="required-mark">*</span></label>
</div>
<div class='zcwf_col_fld'>
<input type='text' id='Company' name='Company' maxlength='200'>
</input>
</div>
</div>
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Designation'>Functie</label>
</div>
<div class='zcwf_col_fld'>
<input type='text' id='Designation' name='Designation' maxlength='100'>
</input>
</div>
</div>
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Mobile'>Telefoonnummer</label>
</div>
<div class='zcwf_col_fld'>
<input type='text' id='Mobile' name='Mobile' maxlength='30'>
</input>
</div>
</div>
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Email'>E-mail</label>
</div>
<div class='zcwf_col_fld'>
<input type='text' ftype='email' id='Email' name='Email' maxlength='100'>
</input>
</div>
</div>
<div class='zcwf_row'>
<div class='zcwf_col_lab'>
<label for='Description'>Uw vraag</label>
</div>
<div class='zcwf_col_fld'>
<textarea id='Description' name='Description' rows="4"></textarea>
</div>
</div>
<div class='zcwf_row'>
<div class='zcwf_col_lab'></div>
<div class='zcwf_col_fld'>
<input type='submit' id='formsubmit' class='formsubmit zcwf_button' value='Verstuur uw verzoek' title='Verstuur uw verzoek'>
<input type='reset' class='zcwf_button' name='reset' value='Terugzetten' title='Terugzetten'>
</div>
</div>
<!-- Response time indicator -->
<div class="response-time">
<svg xmlns="http://www.w3.org/2000/svg" width="20" height="20" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2" stroke-linecap="round" stroke-linejoin="round">
<circle cx="12" cy="12" r="10"></circle>
<polyline points="12 6 12 12 16 14"></polyline>
</svg>
<p>Wij reageren <strong>binnen 24 uur</strong> op uw aanvraag</p>
</div>
<script>
function validateEmail744964000001446306() {
var form = document.forms['WebToLeads744964000001446306'];
var emailFld = form.querySelectorAll('[ftype=email]');
var i;
for (i = 0; i < emailFld.length; i++) {
var emailVal = emailFld[i].value;
if ((emailVal.replace(/^\s+|\s+$/g, '')).length != 0) {
var atpos = emailVal.indexOf('@');
var dotpos = emailVal.lastIndexOf('.');
if (atpos < 1 || dotpos < atpos + 2 || dotpos + 2 >= emailVal.length) {
alert('Voer een geldig e-mailadres in.');
emailFld[i].focus();
return false;
}
}
}
return true;
}
function checkMandatory744964000001446306() {
var mndFileds = new Array('Company', 'Last Name');
var fldLangVal = new Array('Bedrijf', 'Achternaam');
for (i = 0; i < mndFileds.length; i++) {
var fieldObj = document.forms['WebToLeads744964000001446306'][mndFileds[i]];
if (fieldObj) {
if (((fieldObj.value).replace(/^\s+|\s+$/g, '')).length == 0) {
if (fieldObj.type == 'file') {
alert('Selecteer een bestand om te uploaden.');
fieldObj.focus();
return false;
}
alert(fldLangVal[i] + ' kan niet leeg zijn.');
fieldObj.focus();
return false;
} else if (fieldObj.nodeName == 'SELECT') {
if (fieldObj.options[fieldObj.selectedIndex].value == '-None-') {
alert(fldLangVal[i] + ' kan niet geen zijn.');
fieldObj.focus();
return false;
}
} else if (fieldObj.type == 'checkbox') {
if (fieldObj.checked == false) {
alert('Please accept ' + fldLangVal[i]);
fieldObj.focus();
return false;
}
}
try {
if (fieldObj.name == 'Last Name') {
name = fieldObj.value;
}
} catch (e) {}
}
}
trackVisitor744964000001446306();
if (!validateEmail744964000001446306()) {
return false;
}
document.querySelector('.crmWebToEntityForm .formsubmit').setAttribute('disabled', true);
return true;
}
function trackVisitor744964000001446306() {
try {
if ($zoho) {
var LDTuvidObj = document.forms['WebToLeads744964000001446306']['LDTuvid'];
if (LDTuvidObj) {
LDTuvidObj.value = $zoho.salesiq.visitor.uniqueid();
}
var firstnameObj = document.forms['WebToLeads744964000001446306']['First Name'];
if (firstnameObj) {
name = firstnameObj.value + ' ' + name;
}
$zoho.salesiq.visitor.name(name);
var emailObj = document.forms['WebToLeads744964000001446306']['Email'];
if (emailObj) {
email = emailObj.value;
$zoho.salesiq.visitor.email(email);
}
}
} catch (e) {}
}
</script>
<script type='text/javascript' id='VisitorTracking'>
var $zoho = $zoho || {};
$zoho.salesiq = $zoho.salesiq || {
widgetcode: 'siqa62e8c66e7b913341a6f8949ac239611128d2e7d68872887ad6d68f5dbc850f5a8318616e2770c5e33fbedca5d1b1790',
values: {},
ready: function() {}
};
var d = document;
s = d.createElement('script');
s.type = 'text/javascript';
s.id = 'zsiqscript';
s.defer = true;
s.src = 'https://salesiq.zoho.eu/widget';
t = d.getElementsByTagName('script')[0];
t.parentNode.insertBefore(s, t);
</script>
<!-- Do not remove this --- Analytics Tracking code starts -->
<script id='wf_anal' src='https://crm.zohopublic.eu/crm/WebFormAnalyticsServeServlet?rid=59e996e204a979d4b456b9975a8fbe694c322d60f538f0a95ac792e4fa46f22c051185b45c56952185f113e6077aad61gidf6da29b1717eebc83611f3f4c9dd1fc850212ea2972972f8e80c233d11923aecgid5fff40acab59378cad215f7cb79b5d16302302fe754b1b43cbe0f75ba1255a9bgid062cf01228e672fb3776f7e719f06bdf6d75bcbc259b00259452d6ae094b279a&tw=409441abb6cec1454a54b4804c312ad0a9b740d37f8010208302a2a8e04b00e1'></script>
<!-- Do not remove this --- Analytics Tracking code ends. -->
</form>
</div>
<!-- End of Zoho CRM Web-to-Lead Form -->
<div class="form-footer">
<p>Heeft u vragen? Bel ons direct op <strong>085 333 29 80</strong></p>
</div>
</div>
</div>
</div>
</body>
</html>
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