{"id":4171,"date":"2015-07-31T14:16:18","date_gmt":"2015-07-31T14:16:18","guid":{"rendered":"http:\/\/pipi-stop.version-demo.ch\/?page_id=4171"},"modified":"2018-08-06T09:56:36","modified_gmt":"2018-08-06T09:56:36","slug":"online-order","status":"publish","type":"page","link":"https:\/\/www.pipi-stop.ch\/en\/order\/online-order\/","title":{"rendered":"Online Order"},"content":{"rendered":"<p>[et_pb_section bb_built=&#8221;1&#8243; admin_label=&#8221;section&#8221; transparent_background=&#8221;off&#8221; background_color=&#8221;#ffffff&#8221; allow_player_pause=&#8221;off&#8221; inner_shadow=&#8221;off&#8221; parallax=&#8221;off&#8221; parallax_method=&#8221;off&#8221; module_class=&#8221;section_formulaire main-h1-title&#8221;][et_pb_row admin_label=&#8221;row&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221;][et_pb_column type=&#8221;4_4&#8243;][et_pb_text admin_label=&#8221;Order the Pipi-Stop online&#8221; background_layout=&#8221;light&#8221; text_orientation=&#8221;center&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221; module_alignment=&#8221;center&#8221; _builder_version=&#8221;3.0.98&#8243;]<\/p>\n<p>&nbsp;<\/p>\n<h1>Order the Pipi-Stop online<\/h1>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row admin_label=&#8221;row&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221;][et_pb_column type=&#8221;1_2&#8243;][et_pb_text admin_label=&#8221;Rental contract online&#8221; background_layout=&#8221;light&#8221; text_orientation=&#8221;center&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221; module_alignment=&#8221;center&#8221; _builder_version=&#8221;3.0.98&#8243;]<\/p>\n<h1>Rental contract online<\/h1>\n<p>[\/et_pb_text][et_pb_text admin_label=&#8221;VFB form&#8221; background_layout=&#8221;light&#8221; module_class=&#8221;formulaire&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221; _builder_version=&#8221;3.0.98&#8243;]<\/p>\n<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-12\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-12\" value=\"1775594798\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"12\" id=\"\"><div class=\"vfb-form-group vfb-col-12\"><div><h2 class=\"\">Order of the Pipi-Stop<\/h2><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField256\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-well vfb-col-12\" id=\"vfbField257\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">Patient details<\/h3><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField257\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField258\"><div class=\"vfb-form-group\"><label for=\"vfb-field-258\" class=\"vfb-control-label\">Firstname <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-258\" class=\"vfb-form-control\" placeholder=\"Firstname\" required=\"required\" type=\"text\" name=\"vfb-field-258\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField259\"><div class=\"vfb-form-group\"><label for=\"vfb-field-259\" class=\"vfb-control-label\">Lastname <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-259\" class=\"vfb-form-control\" placeholder=\"Lastname\" required=\"required\" type=\"text\" name=\"vfb-field-259\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField260\"><div class=\"vfb-form-group\"><label for=\"vfb-field-260\" class=\"vfb-control-label\">Date of birth  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-260\" class=\"vfb-form-control\" placeholder=\"dd.mm.yyyy\" data-mask=\"00.00.0000\" required=\"required\" type=\"text\" name=\"vfb-field-260\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-radio\" id=\"vfbField261\"><label for=\"vfb-field-261\" class=\"vfb-control-label\">Sex <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-261-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-261\" value=\"M\">M<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-261-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-261\" value=\"F\">F<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField262\"><div class=\"vfb-form-group\"><label for=\"vfb-field-262\" class=\"vfb-control-label\">Name of the health insurance of the patient<\/label><div><input id=\"vfb-field-262\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-262\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField263\"><div class=\"vfb-form-group\"><label for=\"vfb-field-263\" class=\"vfb-control-label\">AVS number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-263\" class=\"vfb-form-control\" placeholder=\"756.xxxx.xxxx.xx\" data-mask=\"756.0000.0000.00\" required=\"required\" data-vfb-minlength=\"16\" data-vfb-maxlength=\"16\" type=\"text\" name=\"vfb-field-263\" value=\"\"><span class=\"vfb-help-block\">This number is to be found on the health insurance card of the patient.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField264\"><div class=\"vfb-form-group\"><label for=\"vfb-field-264\" class=\"vfb-control-label\">Doctor (name and full address)<\/label><div><textarea id=\"vfb-field-264\" class=\"vfb-form-control\" placeholder=\"\" rows=\"6\" name=\"vfb-field-264\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField337\"><div class=\"vfb-form-group\"><label for=\"vfb-field-337\" class=\"vfb-control-label\">Comments about your order<\/label><div><textarea id=\"vfb-field-337\" class=\"vfb-form-control\" placeholder=\"\" rows=\"8\" name=\"vfb-field-337\" cols=\"50\"><\/textarea><span class=\"vfb-help-block\">If necessary, thank you for writing here your comments or further information concerning your order.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField265\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">Legal representative's details<\/h3><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField265\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField266\"><div class=\"vfb-form-group\"><label for=\"vfb-field-266\" class=\"vfb-control-label\">Firstname <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-266\" class=\"vfb-form-control\" placeholder=\"Firstname\" required=\"required\" type=\"text\" name=\"vfb-field-266\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField267\"><div class=\"vfb-form-group\"><label for=\"vfb-field-267\" class=\"vfb-control-label\">Lastname <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-267\" class=\"vfb-form-control\" placeholder=\"Lastname\" required=\"required\" type=\"text\" name=\"vfb-field-267\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField268\"><div class=\"vfb-form-group\"><label for=\"vfb-field-268\" class=\"vfb-control-label\">Street and Nr. <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-268\" class=\"vfb-form-control\" placeholder=\"Example Street 1\" required=\"required\" type=\"text\" name=\"vfb-field-268\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-5 vfb-fieldType-text\" id=\"vfbField269\"><div class=\"vfb-form-group\"><label for=\"vfb-field-269\" class=\"vfb-control-label\">Postal code <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-269\" class=\"vfb-form-control\" placeholder=\"0000\" data-mask=\"0000\" required=\"required\" data-vfb-type=\"digits\" data-vfb-minlength=\"4\" data-vfb-maxlength=\"4\" type=\"text\" name=\"vfb-field-269\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-7 vfb-fieldType-text\" id=\"vfbField270\"><div class=\"vfb-form-group\"><label for=\"vfb-field-270\" class=\"vfb-control-label\">Stadt <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-270\" class=\"vfb-form-control\" placeholder=\"Stadt\" required=\"required\" type=\"text\" name=\"vfb-field-270\" value=\"\"><span class=\"vfb-help-block\">Delivery only available in Swizterland.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField271\"><div class=\"vfb-form-group\"><label for=\"vfb-field-271\" class=\"vfb-control-label\">E-mail for the contact <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-271\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-271\" value=\"\"><span class=\"vfb-help-block\">This e-mail is necessary in order to be able to confirm your order. You will not get advertisements.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField272\"><div class=\"vfb-form-group\"><label for=\"vfb-field-272\" class=\"vfb-control-label\">Confirmation of your e-mail address <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-272\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" data-vfb-equalto=\"#vfb-field-271\" type=\"email\" name=\"vfb-field-272\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField273\"><div class=\"vfb-form-group\"><label for=\"vfb-field-273\" class=\"vfb-control-label\">Phone <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-273\" class=\"vfb-form-control\" placeholder=\"000 000 00 00\" data-mask=\"000 000 00 0#\" required=\"required\" data-vfb-minlength=\"13\" data-vfb-maxlength=\"20\" type=\"text\" name=\"vfb-field-273\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField274\"><div class=\"vfb-form-group\"><label for=\"vfb-field-274\" class=\"vfb-control-label\">Phone 2 (optional)<\/label><div><input id=\"vfb-field-274\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-274\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField275\"><div class=\"vfb-form-group\"><label for=\"vfb-field-275\" class=\"vfb-control-label\">Daytime availability<\/label><div><input id=\"vfb-field-275\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-275\" value=\"\"><span class=\"vfb-help-block\">During the first weeks of the treatment, we contact every family.<br>\r\nWe contact all families within the first few weeks of treatment.\r\nWe can call you during the following hours:<br>\r\nMo - Th: 8am to 12pm and 1:30pm to 5pm<br>\r\nFri: 8am to 12pm<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField276\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">VIBRA as option<\/h3><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField276\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField277\"><label for=\"vfb-field-277\" class=\"vfb-control-label\">I would like to receive the VIBRA (wristband) with the Pipi-Stop <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-277-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-277\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-277-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-277\" value=\"None\">None<\/label><\/div><\/div><span class=\"vfb-help-block\">The VIBRA is optional and can only be used with the Pipi-Stop.<strong> It is not refunded by the basic health insurance.<\/strong> You may send us back the VIBRA wristband at any time, also before the end of the treatment.<\/span><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField278\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">Sending of the Pipi-Stop<\/h3><span class=\"vfb-help-block\">The post office delivers packages Monday to Friday.<\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField278\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField279\"><label for=\"vfb-field-279\" class=\"vfb-control-label\">Desired dispatch date <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-279-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-279\" value=\"As soon as possible\">As soon as possible<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-279-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-279\" value=\"I would like to set a date\">I would like to set a date<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField280\"><div class=\"vfb-form-group\"><label for=\"vfb-field-280\" class=\"vfb-control-label\">Set the sending date of the Pipi-Stop <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-280\" class=\"vfb-form-control\" placeholder=\"dd.mm.yyyy\" data-mask=\"00.00.0000\" required=\"required\" data-vfb-minlength=\"10\" data-vfb-maxlength=\"10\" type=\"text\" name=\"vfb-field-280\" value=\"\"><span class=\"vfb-help-block\">The Pipi-Stop will arrive between 1 and 3 working days after the shipping date.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField281\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">Validation of your order<\/h3><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField281\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField282\"><label for=\"vfb-field-282\" class=\"vfb-control-label\">General conditions <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-282-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-282\" required=\"required\" type=\"checkbox\" name=\"vfb-field-282[0]\" value=\"1\">I have read the <a href=\"https:\/\/www.pipi-stop.ch\/en\/order\/rental-terms\/\" class=\"popmake-9683\" target=\"_blank\">rental terms<\/a> and I accept them<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-hidden\" id=\"vfbField324\"><input id=\"vfb-field-324\" class=\"vfb-form-control\" placeholder=\"\" type=\"hidden\" name=\"vfb-field-324\" value=\"no\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField284\"><button id=\"vfb-field-284\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Send<\/button><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><h4 class=\"form-please-wait-field\">Once you have clicked on \u201cSend\u201d, please wait for a few seconds until you are redirected to the next step.<\/h4><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField330\"><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><\/form>\n<p>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;1_2&#8243;][et_pb_divider admin_label=&#8221;S\u00e9parateur&#8221; color=&#8221;#ffffff&#8221; show_divider=&#8221;off&#8221; height=&#8221;20&#8243; disabled_on=&#8221;on|on|off&#8221;]<br \/>\n[\/et_pb_divider][et_pb_text admin_label=&#8221;Procedure for the online order&#8221; background_layout=&#8221;light&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221; _builder_version=&#8221;3.0.98&#8243;]<\/p>\n<h2><strong>Procedure for the online order<\/strong><\/h2>\n<p>1. <strong>Fill in<\/strong> the online <strong>Rental Contract<\/strong> form entirely and click on &#8220;Send&#8221;<\/p>\n<p>2. You will receive <strong>an e-mail of confirmation<\/strong> immediately after. Open your e-mail inbox and <strong>click on the confirmation link of the order<\/strong> (you will pass on towards an online page of confirmation). Should you not see this e-mail, please, control your <strong>SPAM-Box<\/strong><\/p>\n<p>3. As soon as we have booked your order, you will get an e-mail, informing you that the shipping is under process<\/p>\n<p>4. You will receive the Pipi- Stop at your home in 2-4 working days (or on the chosen date)<\/p>\n<p>[\/et_pb_text][et_pb_divider admin_label=&#8221;S\u00e9parateur&#8221; color=&#8221;#c4c4c4&#8243; show_divider=&#8221;on&#8221; disabled_on=&#8221;on|on|off&#8221;]<br \/>\n[\/et_pb_divider][et_pb_text admin_label=&#8221;Do you need help for your online order?&#8221; background_layout=&#8221;light&#8221; use_border_color=&#8221;off&#8221; background_position=&#8221;top_left&#8221; background_repeat=&#8221;repeat&#8221; background_size=&#8221;initial&#8221; _builder_version=&#8221;3.0.98&#8243;]<\/p>\n<h2>&nbsp;<\/h2>\n<h2><strong>Do you need help for your online order<\/strong>?<\/h2>\n<p>We are at your disposal on the phone to guide you, to fill in the online form or for other questions.<\/p>\n<p><strong>Monday to Friday:&nbsp; 08:00 \u2013 12:00 &nbsp; and &nbsp; 13:30 \u2013 17:00<\/strong><\/p>\n<p><strong>Phone &nbsp;+41 (0)32 \u2013 751 27 95<\/strong><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; Order the Pipi-Stop online Rental contract online <form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-12\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-12\" value=\"1775594798\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"12\" id=\"\"><div class=\"vfb-form-group vfb-col-12\"><div><h2 class=\"\">Order of the Pipi-Stop<\/h2><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField256\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-well vfb-col-12\" id=\"vfbField257\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">Patient details<\/h3><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField257\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField258\"><div class=\"vfb-form-group\"><label for=\"vfb-field-258\" class=\"vfb-control-label\">Firstname <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-258\" class=\"vfb-form-control\" placeholder=\"Firstname\" required=\"required\" type=\"text\" name=\"vfb-field-258\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField259\"><div class=\"vfb-form-group\"><label for=\"vfb-field-259\" class=\"vfb-control-label\">Lastname <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-259\" class=\"vfb-form-control\" placeholder=\"Lastname\" required=\"required\" type=\"text\" name=\"vfb-field-259\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField260\"><div class=\"vfb-form-group\"><label for=\"vfb-field-260\" class=\"vfb-control-label\">Date of birth  <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-260\" class=\"vfb-form-control\" placeholder=\"dd.mm.yyyy\" data-mask=\"00.00.0000\" required=\"required\" type=\"text\" name=\"vfb-field-260\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-radio\" id=\"vfbField261\"><label for=\"vfb-field-261\" class=\"vfb-control-label\">Sex <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-261-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-261\" value=\"M\">M<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-261-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-261\" value=\"F\">F<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField262\"><div class=\"vfb-form-group\"><label for=\"vfb-field-262\" class=\"vfb-control-label\">Name of the health insurance of the patient<\/label><div><input id=\"vfb-field-262\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-262\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField263\"><div class=\"vfb-form-group\"><label for=\"vfb-field-263\" class=\"vfb-control-label\">AVS number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-263\" class=\"vfb-form-control\" placeholder=\"756.xxxx.xxxx.xx\" data-mask=\"756.0000.0000.00\" required=\"required\" data-vfb-minlength=\"16\" data-vfb-maxlength=\"16\" type=\"text\" name=\"vfb-field-263\" value=\"\"><span class=\"vfb-help-block\">This number is to be found on the health insurance card of the patient.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField264\"><div class=\"vfb-form-group\"><label for=\"vfb-field-264\" class=\"vfb-control-label\">Doctor (name and full address)<\/label><div><textarea id=\"vfb-field-264\" class=\"vfb-form-control\" placeholder=\"\" rows=\"6\" name=\"vfb-field-264\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField337\"><div class=\"vfb-form-group\"><label for=\"vfb-field-337\" class=\"vfb-control-label\">Comments about your order<\/label><div><textarea id=\"vfb-field-337\" class=\"vfb-form-control\" placeholder=\"\" rows=\"8\" name=\"vfb-field-337\" cols=\"50\"><\/textarea><span class=\"vfb-help-block\">If necessary, thank you for writing here your comments or further information concerning your order.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField265\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">Legal representative's details<\/h3><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField265\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField266\"><div class=\"vfb-form-group\"><label for=\"vfb-field-266\" class=\"vfb-control-label\">Firstname <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-266\" class=\"vfb-form-control\" placeholder=\"Firstname\" required=\"required\" type=\"text\" name=\"vfb-field-266\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-6 vfb-fieldType-text\" id=\"vfbField267\"><div class=\"vfb-form-group\"><label for=\"vfb-field-267\" class=\"vfb-control-label\">Lastname <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-267\" class=\"vfb-form-control\" placeholder=\"Lastname\" required=\"required\" type=\"text\" name=\"vfb-field-267\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField268\"><div class=\"vfb-form-group\"><label for=\"vfb-field-268\" class=\"vfb-control-label\">Street and Nr. <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-268\" class=\"vfb-form-control\" placeholder=\"Example Street 1\" required=\"required\" type=\"text\" name=\"vfb-field-268\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-5 vfb-fieldType-text\" id=\"vfbField269\"><div class=\"vfb-form-group\"><label for=\"vfb-field-269\" class=\"vfb-control-label\">Postal code <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-269\" class=\"vfb-form-control\" placeholder=\"0000\" data-mask=\"0000\" required=\"required\" data-vfb-type=\"digits\" data-vfb-minlength=\"4\" data-vfb-maxlength=\"4\" type=\"text\" name=\"vfb-field-269\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-col-7 vfb-fieldType-text\" id=\"vfbField270\"><div class=\"vfb-form-group\"><label for=\"vfb-field-270\" class=\"vfb-control-label\">Stadt <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-270\" class=\"vfb-form-control\" placeholder=\"Stadt\" required=\"required\" type=\"text\" name=\"vfb-field-270\" value=\"\"><span class=\"vfb-help-block\">Delivery only available in Swizterland.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField271\"><div class=\"vfb-form-group\"><label for=\"vfb-field-271\" class=\"vfb-control-label\">E-mail for the contact <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-271\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-271\" value=\"\"><span class=\"vfb-help-block\">This e-mail is necessary in order to be able to confirm your order. You will not get advertisements.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField272\"><div class=\"vfb-form-group\"><label for=\"vfb-field-272\" class=\"vfb-control-label\">Confirmation of your e-mail address <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-272\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" data-vfb-equalto=\"#vfb-field-271\" type=\"email\" name=\"vfb-field-272\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField273\"><div class=\"vfb-form-group\"><label for=\"vfb-field-273\" class=\"vfb-control-label\">Phone <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-273\" class=\"vfb-form-control\" placeholder=\"000 000 00 00\" data-mask=\"000 000 00 0#\" required=\"required\" data-vfb-minlength=\"13\" data-vfb-maxlength=\"20\" type=\"text\" name=\"vfb-field-273\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField274\"><div class=\"vfb-form-group\"><label for=\"vfb-field-274\" class=\"vfb-control-label\">Phone 2 (optional)<\/label><div><input id=\"vfb-field-274\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-274\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField275\"><div class=\"vfb-form-group\"><label for=\"vfb-field-275\" class=\"vfb-control-label\">Daytime availability<\/label><div><input id=\"vfb-field-275\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-275\" value=\"\"><span class=\"vfb-help-block\">During the first weeks of the treatment, we contact every family.<br>\r\nWe contact all families within the first few weeks of treatment.\r\nWe can call you during the following hours:<br>\r\nMo - Th: 8am to 12pm and 1:30pm to 5pm<br>\r\nFri: 8am to 12pm<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField276\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">VIBRA as option<\/h3><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField276\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField277\"><label for=\"vfb-field-277\" class=\"vfb-control-label\">I would like to receive the VIBRA (wristband) with the Pipi-Stop <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-277-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-277\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-277-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-277\" value=\"None\">None<\/label><\/div><\/div><span class=\"vfb-help-block\">The VIBRA is optional and can only be used with the Pipi-Stop.<strong> It is not refunded by the basic health insurance.<\/strong> You may send us back the VIBRA wristband at any time, also before the end of the treatment.<\/span><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField278\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">Sending of the Pipi-Stop<\/h3><span class=\"vfb-help-block\">The post office delivers packages Monday to Friday.<\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField278\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField279\"><label for=\"vfb-field-279\" class=\"vfb-control-label\">Desired dispatch date <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-radio\"><label><input id=\"vfb-field-279-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-279\" value=\"As soon as possible\">As soon as possible<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-279-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-279\" value=\"I would like to set a date\">I would like to set a date<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField280\"><div class=\"vfb-form-group\"><label for=\"vfb-field-280\" class=\"vfb-control-label\">Set the sending date of the Pipi-Stop <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-280\" class=\"vfb-form-control\" placeholder=\"dd.mm.yyyy\" data-mask=\"00.00.0000\" required=\"required\" data-vfb-minlength=\"10\" data-vfb-maxlength=\"10\" type=\"text\" name=\"vfb-field-280\" value=\"\"><span class=\"vfb-help-block\">The Pipi-Stop will arrive between 1 and 3 working days after the shipping date.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><div class=\"vfb-well vfb-col-12\" id=\"vfbField281\"><div class=\"vfb-form-group vfb-col-12\"><div><h3 class=\"\">Validation of your order<\/h3><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField281\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField282\"><label for=\"vfb-field-282\" class=\"vfb-control-label\">General conditions <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-inline-group\"><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-282-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-282\" required=\"required\" type=\"checkbox\" name=\"vfb-field-282[0]\" value=\"1\">I have read the <a href=\"https:\/\/www.pipi-stop.ch\/en\/order\/rental-terms\/\" class=\"popmake-9683\" target=\"_blank\">rental terms<\/a> and I accept them<\/label><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-hidden\" id=\"vfbField324\"><input id=\"vfb-field-324\" class=\"vfb-form-control\" placeholder=\"\" type=\"hidden\" name=\"vfb-field-324\" value=\"no\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField284\"><button id=\"vfb-field-284\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Send<\/button><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><h4 class=\"form-please-wait-field\">Once you have clicked on \u201cSend\u201d, please wait for a few seconds until you are redirected to the next step.<\/h4><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField330\"><\/div><div class=\"vfb-clearfix\"><\/div><\/div> <!-- .vfb-well --><\/form> Procedure for the online order 1. Fill in the online Rental Contract form entirely and click on &#8220;Send&#8221; 2. You will receive an e-mail of confirmation immediately after. Open your e-mail inbox and click on the confirmation link of the order (you will pass on [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":2917,"menu_order":31,"comment_status":"open","ping_status":"open","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","inline_featured_image":false,"footnotes":""},"class_list":["post-4171","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.3 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Online Order | Pipi Stop<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.pipi-stop.ch\/en\/order\/online-order\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Online Order\" \/>\n<meta property=\"og:description\" content=\"&nbsp; Order the Pipi-Stop online Rental contract online Procedure for the online order 1. Fill in the online Rental Contract form entirely and click on &quot;Send&quot; 2. You will receive an e-mail of confirmation immediately after. Open your e-mail inbox and click on the confirmation link of the order (you will pass on [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.pipi-stop.ch\/en\/order\/online-order\/\" \/>\n<meta property=\"og:site_name\" content=\"Pipi Stop\" \/>\n<meta property=\"article:modified_time\" content=\"2018-08-06T09:56:36+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.pipi-stop.ch\\\/en\\\/order\\\/online-order\\\/\",\"url\":\"https:\\\/\\\/www.pipi-stop.ch\\\/en\\\/order\\\/online-order\\\/\",\"name\":\"Online Order | Pipi Stop\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.pipi-stop.ch\\\/fr\\\/#website\"},\"datePublished\":\"2015-07-31T14:16:18+00:00\",\"dateModified\":\"2018-08-06T09:56:36+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.pipi-stop.ch\\\/en\\\/order\\\/online-order\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.pipi-stop.ch\\\/en\\\/order\\\/online-order\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.pipi-stop.ch\\\/en\\\/order\\\/online-order\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.pipi-stop.ch\\\/en\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Order\",\"item\":\"https:\\\/\\\/www.pipi-stop.ch\\\/en\\\/order\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Online Order\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.pipi-stop.ch\\\/fr\\\/#website\",\"url\":\"https:\\\/\\\/www.pipi-stop.ch\\\/fr\\\/\",\"name\":\"Pipi Stop\",\"description\":\"\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.pipi-stop.ch\\\/fr\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"Online Order | Pipi Stop","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.pipi-stop.ch\/en\/order\/online-order\/","og_locale":"en_US","og_type":"article","og_title":"Online Order","og_description":"&nbsp; Order the Pipi-Stop online Rental contract online Procedure for the online order 1. 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