{"id":747,"date":"2026-05-28T20:04:51","date_gmt":"2026-05-28T20:04:51","guid":{"rendered":"https:\/\/lumora-raio.com\/?page_id=747"},"modified":"2026-05-28T20:04:52","modified_gmt":"2026-05-28T20:04:52","slug":"chestionar-ro","status":"publish","type":"page","link":"https:\/\/lumora-raio.com\/fr\/chestionar-ro\/","title":{"rendered":"Chestionar RO"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated 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#112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_1' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_1' id='gform_1'  action='\/fr\/wp-json\/wp\/v2\/pages\/747#gf_1' data-formid='1' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_1_39\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_39'>Email<\/label><div class='ginput_container'><input name='input_39' id='input_1_39' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_1_39'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><div id=\"field_1_1\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">1. Informa\u021bii personale<\/h3><div class='gsection_description' id='gfield_description_1_1'>V\u0103 rug\u0103m s\u0103 completa\u021bi toate informa\u021biile personale necesare.<\/div><\/div><fieldset id=\"field_1_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nume \u0219i prenume<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_1_3'>\n                            \n                            <span id='input_1_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_1_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_3_3' class='gform-field-label gform-field-label--type-sub '>Prenume<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_1_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_1_3_6' class='gform-field-label gform-field-label--type-sub '>Nume<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_1_4\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_4'>Data nasterii<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_4' id='input_1_4' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='jj\/mm\/aaaa' aria-describedby=\"input_1_4_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_1_4_date_format' class='screen-reader-text'>JJ slash MM slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_1_4' class='gform_hidden' value='https:\/\/lumora-raio.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_1_5\" class=\"gfield gfield--type-email gfield--input-type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_5'>Adres\u0103 email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_1_5' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_1_6\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_6'>Telefon<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_6' id='input_1_6' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_7\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_7'>\u021aara de reziden\u021b\u0103<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_7' id='input_1_7' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_8\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_8'>Na\u021bionalitate<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_1_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_9\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_9'>Profesie<\/label><div class='ginput_container ginput_container_text'><input name='input_9' id='input_1_9' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_10'>Limba preferat\u0103 pentru consulta\u021bie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_1_10' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Rom\u00e2n\u0103' >Rom\u00e2n\u0103<\/option><option value='Fran\u00e7ais' >Fran\u00e7ais<\/option><option value='\u0420\u0443\u0441\u0441\u043a\u0438\u0439' >\u0420\u0443\u0441\u0441\u043a\u0438\u0439<\/option><option value='English' >English<\/option><\/select><\/div><\/div><div id=\"field_1_11\" class=\"gfield gfield--type-select gfield--input-type-select field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_11'>Stare civil\u0103<\/label><div class='ginput_container ginput_container_select'><select name='input_11' id='input_1_11' class='large gfield_select'     aria-invalid=\"false\" ><option value='Nec\u0103s\u0103torit\u0103' >Nec\u0103s\u0103torit\u0103<\/option><option value='C\u0103s\u0103torit\u0103' >C\u0103s\u0103torit\u0103<\/option><option value='Divor\u021bat\u0103' >Divor\u021bat\u0103<\/option><option value='V\u0103duv\u0103' >V\u0103duv\u0103<\/option><option value='Alt\u0103 situa\u021bie' >Alt\u0103 situa\u021bie<\/option><\/select><\/div><\/div><div id=\"field_1_12\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">2. Tipul consulta\u021biei solicitate<\/h3><\/div><fieldset id=\"field_1_13\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Tipul consulta\u021biei solicitate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_13'>\n\t\t\t<div class='gchoice gchoice_1_13_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Consulta\u021bie online \u2014 100\u20ac'  id='choice_1_13_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_0' id='label_1_13_0' class='gform-field-label gform-field-label--type-inline'>Consulta\u021bie online \u2014 100\u20ac<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_13_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_13' type='radio' value='Second opinion ginecologic avansat \u2014 170\u20ac'  id='choice_1_13_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_13_1' id='label_1_13_1' class='gform-field-label gform-field-label--type-inline'>Second opinion ginecologic avansat \u2014 170\u20ac<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_1_14\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Program preferat pentru consulta\u021bie<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_1_14'>\n\t\t\t<div class='gchoice gchoice_1_14_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Luni seara \u2014 disponibilitate consulta\u021bii online \u00eentre 19:30\u201320:30 (Paris time)'  id='choice_1_14_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_0' id='label_1_14_0' class='gform-field-label gform-field-label--type-inline'>Luni seara \u2014 disponibilitate consulta\u021bii online \u00eentre 19:30\u201320:30 (Paris time)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_1_14_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_14' type='radio' value='Joi seara \u2014 disponibilitate consulta\u021bii online \u00eentre 19:30\u201320:30 (Paris time)'  id='choice_1_14_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_1_14_1' id='label_1_14_1' class='gform-field-label gform-field-label--type-inline'>Joi seara \u2014 disponibilitate consulta\u021bii online \u00eentre 19:30\u201320:30 (Paris time)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_1_16\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_16'>Solicitare programare rapid\u0103 \/ interval diferit<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_1_16' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_16\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_16'>Solicitare programare rapid\u0103 sau \u00een afara intervalelor standard (\u00een func\u021bie de disponibilitate \u0219i posibil asociat\u0103 cu tax\u0103 suplimentar\u0103)<\/div><\/div><div id=\"field_1_17\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">3. Motivul consulta\u021biei<\/h3><\/div><div id=\"field_1_18\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_18'>Motivul principal al consulta\u021biei<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_18' id='input_1_18' class='textarea large'  aria-describedby=\"gfield_description_1_18\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_1_18'>Descrie\u021bi motivul consulta\u021biei, simptomele principale, de c\u00e2nd au \u00eenceput, cum au evoluat \u00een timp, cu ce sunt asociate \u0219i ce factori le accentueaz\u0103 sau le diminueaz\u0103.<\/div><\/div><div id=\"field_1_20\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">4. Anamnez\u0103 personal\u0103 fiziologic\u0103<\/h3><\/div><div id=\"field_1_21\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_21'>Menstrua\u021bie \u0219i caracteristicile ciclului menstrual<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_1_21' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_21\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_21'>Debutul menstrua\u021biei, dac\u0103 ciclurile au devenit regulate \u00een primul an dup\u0103 debut, caracteristicile actuale ale ciclurilor menstruale, durata ciclurilor, durata menstrua\u021biei, dac\u0103 menstrua\u021biile sunt abundente sau dureroase \u0219i dac\u0103 sunt \u00eenso\u021bite de alte simptome.<\/div><\/div><div id=\"field_1_22\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_22'>Activitate sexual\u0103<\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_1_22' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_22\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_22'>Debutul vie\u021bii sexuale, dac\u0103 exist\u0103 partener stabil, activitate sexual\u0103 actual\u0103, disconfort sau durere la contact sexual, s\u00e2nger\u0103ri dup\u0103 contact sexual \u0219i antecedente de infec\u021bii genitale sau boli cu transmitere sexual\u0103.<\/div><\/div><div id=\"field_1_23\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_23'>Contracep\u021bie<\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_1_23' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_23\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_23'>Metode contraceptive utilizate \u00een prezent sau anterior, toleran\u021b\u0103 la contracep\u021bie hormonal\u0103 \u0219i eventuale reac\u021bii adverse sau complica\u021bii.<\/div><\/div><div id=\"field_1_24\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_24'>Antecedente obstetricale<\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_1_24' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_24\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_24'>Num\u0103rul de sarcini, na\u0219teri, na\u0219teri naturale, opera\u021bii cezariene, avorturi spontane sau provocate, sarcini extrauterine, complica\u021bii \u00een timpul sarcinii \u0219i eventuale tratamente pentru infertilitate.<\/div><\/div><div id=\"field_1_25\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_25'>Menopauz\u0103 \/ Perimenopauz\u0103<\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_1_25' type='text' value='' class='large'  aria-describedby=\"gfield_description_1_25\"    aria-invalid=\"false\"   \/><\/div><div class='gfield_description' id='gfield_description_1_25'>Menopauz\u0103 sau perimenopauz\u0103, v\u00e2rsta instal\u0103rii menopauzei, simptome asociate, tratamente hormonale utilizate \u0219i evolu\u021bia simptomatologiei.<\/div><\/div><div id=\"field_1_27\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_27'>Mod de via\u021b\u0103 \u0219i factori generali<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_1_27' class='textarea large'  aria-describedby=\"gfield_description_1_27\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_1_27'>\u00cen\u0103l\u021bime, greutate, activitate fizic\u0103, regim alimentar, eventuale noxe profesionale, stres profesional, program de lucru, fumat, alcool, alte vicii, alergii cunoscute \u0219i alte informa\u021bii generale importante privind stilul de via\u021b\u0103.<\/div><\/div><div id=\"field_1_28\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">5. Antecedente heredo-colaterale<\/h3><\/div><div id=\"field_1_29\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_29'>Afec\u021biuni importante \u00een familie: cancer mamar, ovarian, uterin, colorectal, endometrioz\u0103, infertilitate, tromboze, boli endocrine, boli autoimune sau alte afec\u021biuni familiale importante.<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_1_29' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_1_30\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">6. Anamnez\u0103 personal\u0103 patologic\u0103<\/h3><\/div><div id=\"field_1_32\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_32'>Afec\u021biuni medicale \u0219i ginecologice diagnosticate anterior, interven\u021bii chirurgicale, spitaliz\u0103ri, infec\u021bii importante, traumatisme, evolu\u021bia acestora \u0219i eventuale complica\u021bii.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_32' id='input_1_32' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_1_34\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_1_34'>Tratament de fond<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_34' id='input_1_34' class='textarea large'  aria-describedby=\"gfield_description_1_34\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_1_34'>Tratament administrat \u00een prezent pentru afec\u021biuni cronice sau alte probleme medicale, inclusiv tratamente hormonale sau suplimente.<\/div><\/div><div id=\"field_1_35\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">7. Documente medicale<\/h3><div class='gsection_description' id='gfield_description_1_35'>Analize, ecografii, RMN\/CT, rezultate HPV\/Papanicolau, scrisori medicale, rapoarte operatorii, rezultate histopatologice sau alte documente relevante.\n\nV\u0103 rug\u0103m s\u0103 \u00eenc\u0103rca\u021bi concluziile \u0219i rapoartele medicale oficiale disponibile. Interpretarea investiga\u021biilor imagistice \u0219i paraclinice trebuie realizat\u0103 de c\u0103tre medicul specialist care a efectuat sau validat investiga\u021bia respectiv\u0103.\n\n<\/div><\/div><div id=\"field_1_36\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_1_36'>\u00cenc\u0103rca\u021bi documentele medicale relevante disponibile - trebuie \u00eenc\u0103rcate cu minimum 48 ore \u00eenaintea intervalului ales pentru consulta\u021bie.<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_1_36' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_1_36&quot;,&quot;container&quot;:&quot;gform_multifile_upload_1_36&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_1_36&quot;,&quot;filelist&quot;:&quot;gform_preview_1_36&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/lumora-raio.com\\\/?gf_page=6d2874bcae919b3&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/lumora-raio.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/lumora-raio.com\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;8388608b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:1,&quot;field_id&quot;:36,&quot;_gform_file_upload_nonce_1_36&quot;:&quot;b0707cea54&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_1_36&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_1_36' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>D\u00e9posez les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_1_36' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_1_36 gfield_description_1_36\"  >S\u00e9lectionnez des fichiers<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_1_36'>Taille max. des fichiers\u00a0: 8 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_1_36'><\/ul> <div id='gform_preview_1_36' class='ginput_preview_list'><\/div><\/div><div class='gfield_description' id='gfield_description_1_36'>V\u0103 rug\u0103m s\u0103 \u00eenc\u0103rca\u021bi concluziile \u0219i rapoartele medicale oficiale disponibile. Interpretarea investiga\u021biilor imagistice \u0219i paraclinice trebuie realizat\u0103 de c\u0103tre medicul specialist care a efectuat sau validat investiga\u021bia respectiv\u0103.<\/div><\/div><div id=\"field_1_37\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">8. Consim\u021b\u0103m\u00e2nt \u0219i confirmare<\/h3><\/div><fieldset id=\"field_1_38\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Confirm urm\u0103toarele:<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_1_38'><div class='gchoice gchoice_1_38_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.1' type='checkbox'  value='Informa\u021biile furnizate sunt corecte \u0219i complete.'  id='choice_1_38_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_38_1' id='label_1_38_1' class='gform-field-label gform-field-label--type-inline'>Informa\u021biile furnizate sunt corecte \u0219i complete.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_38_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.2' type='checkbox'  value='\u00cen\u021beleg limit\u0103rile consulta\u021biei online \u00een absen\u021ba examin\u0103rii clinice directe.'  id='choice_1_38_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_38_2' id='label_1_38_2' class='gform-field-label gform-field-label--type-inline'>\u00cen\u021beleg limit\u0103rile consulta\u021biei online \u00een absen\u021ba examin\u0103rii clinice directe.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_38_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.3' type='checkbox'  value='\u00cen\u021beleg c\u0103 acest serviciu nu \u00eenlocuie\u0219te asisten\u021ba medical\u0103 de urgen\u021b\u0103.'  id='choice_1_38_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_38_3' id='label_1_38_3' class='gform-field-label gform-field-label--type-inline'>\u00cen\u021beleg c\u0103 acest serviciu nu \u00eenlocuie\u0219te asisten\u021ba medical\u0103 de urgen\u021b\u0103.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_38_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.4' type='checkbox'  value='Sunt de acord cu procesarea \u0219i stocarea securizat\u0103 a datelor medicale pentru scopuri medicale.'  id='choice_1_38_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_38_4' id='label_1_38_4' class='gform-field-label gform-field-label--type-inline'>Sunt de acord cu procesarea \u0219i stocarea securizat\u0103 a datelor medicale pentru scopuri medicale.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_38_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.5' type='checkbox'  value='Sunt de acord cu utilizarea sistemelor informatice \u0219i AI ca suport pentru analiza medical\u0103 sub supraveghere medical\u0103.'  id='choice_1_38_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_38_5' id='label_1_38_5' class='gform-field-label gform-field-label--type-inline'>Sunt de acord cu utilizarea sistemelor informatice \u0219i AI ca suport pentru analiza medical\u0103 sub supraveghere medical\u0103.<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_1_38_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_38.6' type='checkbox'  value='Confirm c\u0103 am citit, am \u00een\u021beles \u0219i am acceptat Termenii \u0219i Condi\u021biile Consulta\u021biei Ginecologice Online, Politica de Confiden\u021bialitate (GDPR), Politica de Anulare \u0219i Rambursare \u0219i Consim\u021b\u0103m\u00e2ntul pentru Teleconsulta\u021bie \u0219i \u00eemi exprim acordul pentru procesarea, utilizarea \u0219i stocarea securizat\u0103 a datelor \u0219i documentelor mele medicale \u00een scopul consulta\u021biei, evalu\u0103rii medicale, orient\u0103rii diagnostice, ob\u021binerii unei a doua opinii medicale, 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