{"id":3379,"date":"2026-05-11T09:50:27","date_gmt":"2026-05-11T09:50:27","guid":{"rendered":"https:\/\/www.penisprothese.com\/evaluation-ed\/"},"modified":"2026-05-11T09:50:27","modified_gmt":"2026-05-11T09:50:27","slug":"evaluation-ed","status":"publish","type":"page","link":"https:\/\/www.penisprothese.com\/fr\/evaluation-ed\/","title":{"rendered":"\u00c9valuation de la DE"},"content":{"rendered":"<h3>\u00c9valuation de la DE ~ 5 min<\/h3>\n<hr>\n<div>\n<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 in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework gppt-has-page-transitions_wrapper gform-theme__no-reset--el_wrapper' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_2' >\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_2' id='gform_2' class='gppt-has-page-transitions gform-theme__no-reset--el ' action='\/fr\/wp-json\/wp\/v2\/pages\/3379' data-formid='2' novalidate><input type=\"hidden\" name=\"gpuid_existing_value_41\" id=\"gpuid_existing_value_41\" value=\"b80cf66691c7a1ad28962e2f3a58df0d\" \/><input type=\"hidden\" value=\"0\" name=\"gpps_page_progression_2\" \/>\n        <div id='gf_progressbar_wrapper_2' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>9<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_11' style='width:11%;'><span>11%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_2_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_43\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"uk-alert uk-alert-primary\" data-id=\"page#6\">\n    \n                <h5 class=\"el-title\">Es gibt viele Gr\u00fcnde f\u00fcr ED. Dieses einfache Quiz zur erektilen Dysfunktion hilft Ihnen dabei, den Schweregrad Ihrer Symptome einer erektilen Dysfunktion und die Auswirkungen, die eine erektile Dysfunktion auf Ihr Leben haben kann, einzusch\u00e4tzen. \u2705 Seien Sie versichert, dass keine pers\u00f6nlichen Informationen wie Ihr Name ben\u00f6tigt werden, um Ihre ED-Bewertungsergebnisse einzusehen, und das System wird eine zuf\u00e4llige ID f\u00fcr Sie generieren.\n\nHinweis: Dieses Quiz ersetzt keine \u00e4rztliche Diagnose. Ihre Daten werden gem\u00e4\u00df DSGVO und HIPAA verarbeitet.\n\n\n\n<\/h5>        \n        \n    \n<\/div><\/div><fieldset id=\"field_2_38\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gppt-auto-progress-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy \"  data-field-class=\"image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy\" ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Haben Sie oder Ihr Partner morgendliche Erektionen?<\/span><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_2_38'>\n\t\t\t<div class='gchoice gchoice_2_38_0 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Ja'  id='choice_2_38_0' onchange='gformToggleRadioOther( this )'  tabindex='49'  \/>\n\t\t\t\t\t<label  for='choice_2_38_0' id='label_2_38_0' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/user.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/user.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"\" \/><\/span><span class=\"image-choices-choice-text\">Ja<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_38_1 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Nein'  id='choice_2_38_1' onchange='gformToggleRadioOther( this )'  tabindex='50'  \/>\n\t\t\t\t\t<label  for='choice_2_38_1' id='label_2_38_1' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/user.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/user.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"\" \/><\/span><span class=\"image-choices-choice-text\">Nein<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_2_7' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='51'>Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_2' class='gform_page' data-js='page-field-id-7' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gppt-auto-progress-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy \"  data-field-class=\"image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy\" ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Wie beurteilen Sie Ihre F\u00e4higkeit, eine Erektion bekommen und halten zu k\u00f6nnen?<\/span><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_2_8'>\n\t\t\t<div class='gchoice gchoice_2_8_0 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='1'  id='choice_2_8_0' onchange='gformToggleRadioOther( this )'  tabindex='52'  \/>\n\t\t\t\t\t<label  for='choice_2_8_0' id='label_2_8_0' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-01-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-01-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-01.png\" \/><\/span><span class=\"image-choices-choice-text\">Sehr langsam<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_1 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='2'  id='choice_2_8_1' onchange='gformToggleRadioOther( this )'  tabindex='53'  \/>\n\t\t\t\t\t<label  for='choice_2_8_1' id='label_2_8_1' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-02-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-02-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-02.png\" \/><\/span><span class=\"image-choices-choice-text\">Langsam<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_2 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='3'  id='choice_2_8_2' onchange='gformToggleRadioOther( this )'  tabindex='54'  \/>\n\t\t\t\t\t<label  for='choice_2_8_2' id='label_2_8_2' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Medium.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Medium.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"\" \/><\/span><span class=\"image-choices-choice-text\">Moderat<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_3 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='4'  id='choice_2_8_3' onchange='gformToggleRadioOther( this )'  tabindex='55'  \/>\n\t\t\t\t\t<label  for='choice_2_8_3' id='label_2_8_3' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-04-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-04-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-04.png\" \/><\/span><span class=\"image-choices-choice-text\">Hoch<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_8_4 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='5'  id='choice_2_8_4' onchange='gformToggleRadioOther( this )'  tabindex='56'  \/>\n\t\t\t\t\t<label  for='choice_2_8_4' id='label_2_8_4' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-05-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-05-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-1-05.png\" \/><\/span><span class=\"image-choices-choice-text\">Sehr hoch<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_2_10' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='57'>Vorherige<\/button> <button type='button' id='gform_next_button_2_10' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='58'>N\u00e4chste<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_3' class='gform_page' data-js='page-field-id-10' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_3' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_9\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gppt-auto-progress-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy \"  data-field-class=\"image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy\" ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Wenn Sie bei sexueller Stimulation eine Erektion hatten; Wie lange war Ihre Erektion kr\u00e4ftig und steif genug f\u00fcr eine Penetration? (Eindringen in Ihren Partner<\/span><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_2_9'>\n\t\t\t<div class='gchoice gchoice_2_9_0 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='0'  id='choice_2_9_0' onchange='gformToggleRadioOther( this )'  tabindex='59'  \/>\n\t\t\t\t\t<label  for='choice_2_9_0' id='label_2_9_0' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-01-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-01-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-01.png\" \/><\/span><span class=\"image-choices-choice-text\">Keine sexuelle Aktivit\u00e4t<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_1 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='1'  id='choice_2_9_1' onchange='gformToggleRadioOther( this )'  tabindex='60'  \/>\n\t\t\t\t\t<label  for='choice_2_9_1' id='label_2_9_1' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-02-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-02-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-02.png\" \/><\/span><span class=\"image-choices-choice-text\">Fast nie oder nie<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_2 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='2'  id='choice_2_9_2' onchange='gformToggleRadioOther( this )'  tabindex='61'  \/>\n\t\t\t\t\t<label  for='choice_2_9_2' id='label_2_9_2' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-03-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-03-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-03.png\" \/><\/span><span class=\"image-choices-choice-text\">Einige Male (weniger als die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_3 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='3'  id='choice_2_9_3' onchange='gformToggleRadioOther( this )'  tabindex='62'  \/>\n\t\t\t\t\t<label  for='choice_2_9_3' id='label_2_9_3' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-04-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-04-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-04.png\" \/><\/span><span class=\"image-choices-choice-text\">Manchmal (etwa die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_4 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='4'  id='choice_2_9_4' onchange='gformToggleRadioOther( this )'  tabindex='63'  \/>\n\t\t\t\t\t<label  for='choice_2_9_4' id='label_2_9_4' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-05-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-05-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-05.png\" \/><\/span><span class=\"image-choices-choice-text\">Die meiste Zeit (mehr als die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_9_5 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_9' type='radio' value='5'  id='choice_2_9_5' onchange='gformToggleRadioOther( this )'  tabindex='64'  \/>\n\t\t\t\t\t<label  for='choice_2_9_5' id='label_2_9_5' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-06-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-06-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-2-06.png\" \/><\/span><span class=\"image-choices-choice-text\">Fast immer oder immer<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_2_11' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='65'>Vorherige<\/button> <button type='button' id='gform_next_button_2_11' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='66'>N\u00e4chste<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_4' class='gform_page' data-js='page-field-id-11' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_4' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gppt-auto-progress-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy \"  data-field-class=\"image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy\" ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Wie oft waren Sie w\u00e4hrend des Geschlechtsverkehrs in der Lage, eine Erektion aufrechtzuerhalten, nachdem Sie in Ihren Partner eingedrungen waren?<\/span><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_2_12'>\n\t\t\t<div class='gchoice gchoice_2_12_0 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='0'  id='choice_2_12_0' onchange='gformToggleRadioOther( this )'  tabindex='67'  \/>\n\t\t\t\t\t<label  for='choice_2_12_0' id='label_2_12_0' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-01-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-01-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-01.png\" \/><\/span><span class=\"image-choices-choice-text\">Nicht mehr versuchen, Geschlechtsverkehr zu haben<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_1 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='1'  id='choice_2_12_1' onchange='gformToggleRadioOther( this )'  tabindex='68'  \/>\n\t\t\t\t\t<label  for='choice_2_12_1' id='label_2_12_1' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-02-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-02-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-02.png\" \/><\/span><span class=\"image-choices-choice-text\">Fast nie oder nie<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_2 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='2'  id='choice_2_12_2' onchange='gformToggleRadioOther( this )'  tabindex='69'  \/>\n\t\t\t\t\t<label  for='choice_2_12_2' id='label_2_12_2' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-03-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-03-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-03.png\" \/><\/span><span class=\"image-choices-choice-text\">Einige Male (weniger als die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_3 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='3'  id='choice_2_12_3' onchange='gformToggleRadioOther( this )'  tabindex='70'  \/>\n\t\t\t\t\t<label  for='choice_2_12_3' id='label_2_12_3' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-04-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-04-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-04.png\" \/><\/span><span class=\"image-choices-choice-text\">Manchmal (etwa die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_4 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='4'  id='choice_2_12_4' onchange='gformToggleRadioOther( this )'  tabindex='71'  \/>\n\t\t\t\t\t<label  for='choice_2_12_4' id='label_2_12_4' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-05-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-05-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-05.png\" \/><\/span><span class=\"image-choices-choice-text\">Die meiste Zeit (mehr als die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_12_5 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='5'  id='choice_2_12_5' onchange='gformToggleRadioOther( this )'  tabindex='72'  \/>\n\t\t\t\t\t<label  for='choice_2_12_5' id='label_2_12_5' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-06-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-06-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-3-06.png\" \/><\/span><span class=\"image-choices-choice-text\">Fast immer oder immer<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_2_13' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='73'>Vorherige<\/button> <button type='button' id='gform_next_button_2_13' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='74'>N\u00e4chste<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_5' class='gform_page' data-js='page-field-id-13' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_5' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_15\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gppt-auto-progress-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy \"  data-field-class=\"image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy\" ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Wie schwierig war es, w\u00e4hrend des Geschlechtsverkehrs Ihre Erektion bis zum Ende des Geschlechtsverkehrs aufrechtzuerhalten?<\/span><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_2_15'>\n\t\t\t<div class='gchoice gchoice_2_15_0 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='0'  id='choice_2_15_0' onchange='gformToggleRadioOther( this )'  tabindex='75'  \/>\n\t\t\t\t\t<label  for='choice_2_15_0' id='label_2_15_0' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-01-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-01-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-01.png\" \/><\/span><span class=\"image-choices-choice-text\">Hat nicht versucht, Geschlechtsverkehr zu haben<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_1 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='1'  id='choice_2_15_1' onchange='gformToggleRadioOther( this )'  tabindex='76'  \/>\n\t\t\t\t\t<label  for='choice_2_15_1' id='label_2_15_1' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-02-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-02-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-02.png\" \/><\/span><span class=\"image-choices-choice-text\">Extrem schwierig<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_2 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='2'  id='choice_2_15_2' onchange='gformToggleRadioOther( this )'  tabindex='77'  \/>\n\t\t\t\t\t<label  for='choice_2_15_2' id='label_2_15_2' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-03-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-03-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-03.png\" \/><\/span><span class=\"image-choices-choice-text\">Sehr schwierig<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_3 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='3'  id='choice_2_15_3' onchange='gformToggleRadioOther( this )'  tabindex='78'  \/>\n\t\t\t\t\t<label  for='choice_2_15_3' id='label_2_15_3' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-04-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-04-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-04.png\" \/><\/span><span class=\"image-choices-choice-text\">Schwierig<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_4 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='4'  id='choice_2_15_4' onchange='gformToggleRadioOther( this )'  tabindex='79'  \/>\n\t\t\t\t\t<label  for='choice_2_15_4' id='label_2_15_4' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-05-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-05-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-05.png\" \/><\/span><span class=\"image-choices-choice-text\">Ein bisschen schwierig<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_15_5 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_15' type='radio' value='5'  id='choice_2_15_5' onchange='gformToggleRadioOther( this )'  tabindex='80'  \/>\n\t\t\t\t\t<label  for='choice_2_15_5' id='label_2_15_5' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-06-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-06-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-4-06.png\" \/><\/span><span class=\"image-choices-choice-text\">Nicht schwierig<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_2_16' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='81'>Vorherige<\/button> <button type='button' id='gform_next_button_2_16' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='82'>N\u00e4chste<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_6' class='gform_page' data-js='page-field-id-16' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gppt-auto-progress-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy \"  data-field-class=\"image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy\" ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Wenn Sie versucht haben, Geschlechtsverkehr zu haben, wie oft war er f\u00fcr Sie befriedigend?<\/span><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_2_17'>\n\t\t\t<div class='gchoice gchoice_2_17_0 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='0'  id='choice_2_17_0' onchange='gformToggleRadioOther( this )'  tabindex='83'  \/>\n\t\t\t\t\t<label  for='choice_2_17_0' id='label_2_17_0' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-01-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-01-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-01.png\" \/><\/span><span class=\"image-choices-choice-text\">Fast nie oder nie<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_1 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='1'  id='choice_2_17_1' onchange='gformToggleRadioOther( this )'  tabindex='84'  \/>\n\t\t\t\t\t<label  for='choice_2_17_1' id='label_2_17_1' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-02-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-02-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-02.png\" \/><\/span><span class=\"image-choices-choice-text\">Einige Male (weniger als die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_2 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='2'  id='choice_2_17_2' onchange='gformToggleRadioOther( this )'  tabindex='85'  \/>\n\t\t\t\t\t<label  for='choice_2_17_2' id='label_2_17_2' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-03-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-03-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-03.png\" \/><\/span><span class=\"image-choices-choice-text\">Manchmal (etwa die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_3 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='3'  id='choice_2_17_3' onchange='gformToggleRadioOther( this )'  tabindex='86'  \/>\n\t\t\t\t\t<label  for='choice_2_17_3' id='label_2_17_3' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-04-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-04-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-04.png\" \/><\/span><span class=\"image-choices-choice-text\">Die meiste Zeit (mehr als die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_4 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='4'  id='choice_2_17_4' onchange='gformToggleRadioOther( this )'  tabindex='87'  \/>\n\t\t\t\t\t<label  for='choice_2_17_4' id='label_2_17_4' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-05-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-05-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-05.png\" \/><\/span><span class=\"image-choices-choice-text\">Meistens (mehr als die H\u00e4lfte der Zeit)<\/span><\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_2_17_5 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='5'  id='choice_2_17_5' onchange='gformToggleRadioOther( this )'  tabindex='88'  \/>\n\t\t\t\t\t<label  for='choice_2_17_5' id='label_2_17_5' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-06-300x300.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-06-300x300.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2023\/06\/step-5-06.png\" \/><\/span><span class=\"image-choices-choice-text\">Fast immer oder immer<\/span><\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_2_18' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='89'>Vorherige<\/button> <button type='button' id='gform_next_button_2_18' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='90'>N\u00e4chste<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_7' class='gform_page' data-js='page-field-id-18' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_7' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_24\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy \"  data-field-class=\"image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>W\u00e4hlen Sie alle Behandlungen aus, die Sie ausprobiert haben. (Mehrfachauswahl m\u00f6glich)<\/span><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_2_24'><div class='gchoice gchoice_2_24_1 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.1' type='checkbox'  value='Pillen'  id='choice_2_24_1' tabindex='91'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_24_1' id='label_2_24_1' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/pill.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/pill.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/pill.png\" \/><\/span><span class=\"image-choices-choice-text\">Pillen<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_24_2 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.2' type='checkbox'  value='Vakuumpumpe'  id='choice_2_24_2' tabindex='92'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_24_2' id='label_2_24_2' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Vacuum.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Vacuum.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Vacuum.png\" \/><\/span><span class=\"image-choices-choice-text\">Vakuumpumpe<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_24_3 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.3' type='checkbox'  value='Injektion'  id='choice_2_24_3' tabindex='93'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_24_3' id='label_2_24_3' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/injections.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/injections.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/injections.png\" \/><\/span><span class=\"image-choices-choice-text\">Injektion<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_24_4 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.4' type='checkbox'  value='Z\u00e4pfchen'  id='choice_2_24_4' tabindex='94'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_24_4' id='label_2_24_4' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Supp.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Supp.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Supp.png\" \/><\/span><span class=\"image-choices-choice-text\">Z\u00e4pfchen<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_24_5 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_24.5' type='checkbox'  value='Nichts'  id='choice_2_24_5' tabindex='95'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_24_5' id='label_2_24_5' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/none.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/none.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/none.png\" \/><\/span><span class=\"image-choices-choice-text\">Nichts<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_2_20' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='96'>Vorherige<\/button> <button type='button' id='gform_next_button_2_20' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='97'>N\u00e4chste<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_8' class='gform_page' data-js='page-field-id-20' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_8' class='gform_fields top_label form_sublabel_below description_below validation_below'><fieldset id=\"field_2_23\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy \"  data-field-class=\"image-choices-field image-choices-use-images image-choices-show-labels ic-lightbox-captions has-jetsloth-lazy\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Wurde bei Ihnen eine der folgenden medizinischen Erkrankungen diagnostiziert, die mit erektiler Dysfunktion in Verbindung stehen k\u00f6nnen? (Mehrfachauswahl m\u00f6glich)<\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_2_23'><div class='gchoice gchoice_2_23_1 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.1' type='checkbox'  value='Diabetes'  id='choice_2_23_1' tabindex='98'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_23_1' id='label_2_23_1' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Diabetes.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Diabetes.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/Diabetes.png\" \/><\/span><span class=\"image-choices-choice-text\">Diabetes<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_2 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.2' type='checkbox'  value='Prostatakrebs'  id='choice_2_23_2' tabindex='99'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_23_2' id='label_2_23_2' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/prostate-cancer.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/prostate-cancer.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/prostate-cancer.png\" \/><\/span><span class=\"image-choices-choice-text\">Prostatakrebs<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_3 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.3' type='checkbox'  value='Kardiopathie'  id='choice_2_23_3' tabindex='100'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_23_3' id='label_2_23_3' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/heart.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/heart.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/heart.png\" \/><\/span><span class=\"image-choices-choice-text\">Kardiopathie<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_2_23_4 image-choices-choice gform-theme__no-reset--children'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_23.4' type='checkbox'  value='Nichts'  id='choice_2_23_4' tabindex='101'  \/>\n\t\t\t\t\t\t\t\t<label  for='choice_2_23_4' id='label_2_23_4' class='gform-field-label gform-field-label--type-inline' ><span class=\"image-choices-choice-image-wrap\" style=\"background-image:url(https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/none.png)\"><img decoding=\"async\" src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/none.png\" alt=\"\" class=\"image-choices-choice-image\" data-lightbox-src=\"https:\/\/www.penisprothese.com\/wp-content\/uploads\/2021\/11\/none.png\" \/><\/span><span class=\"image-choices-choice-text\">Nichts<\/span><\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_2_25' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='102'>Vorherige<\/button> <button type='button' id='gform_next_button_2_25' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='103'>N\u00e4chste<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_2_9' class='gform_page' data-js='page-field-id-25' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_2_9' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_2_33\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3>Erhalten Sie Ihre personalisierten Ergebnisse in Ihrem Posteingang.<\/h3><\/div><div id=\"field_2_41\" class=\"gfield gfield--type-uid gfield--input-type-uid gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><label class='gfield_label gform-field-label' for='input_2_41'><span class='gform-field-label__text'>ID<\/span><\/label><div class='ginput_container ginput_container_hidden'><input name='input_41' id='input_2_41' type='hidden' value=''  \/><\/div><\/div><div id=\"field_2_28\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full 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_2_28'><span class='gform-field-label__text'>Alter<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_28' id='input_2_28' type='number' step='any' min='18' max='120' value='' class='large' tabindex='104'    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_instruction_2_28\" \/><div class='gfield_description instruction ' id='gfield_instruction_2_28'>Veuillez saisir un nombre entre <strong>18<\/strong> et <strong>120<\/strong>.<\/div><\/div><\/div><div id=\"field_2_34\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-international gfield--width-half 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_2_34'><span class='gform-field-label__text'>Telefon<\/span><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_34' id='input_2_34' type='tel' value='' class='large' tabindex='105' placeholder='Beispiel: +49 1725351114' aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"tel\"  \/><\/div><\/div><div id=\"field_2_27\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half 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_2_27'><span class='gform-field-label__text'>E-Mail<\/span><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_27' id='input_2_27' type='email' value='' class='large' tabindex='106'   aria-required=\"true\" aria-invalid=\"false\"  autocomplete=\"email\"\/>\n                        <\/div><\/div><div id=\"field_2_44\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><div class=\"uk-alert uk-alert-primary boxdarius\">Warum? Wir bitten um Ihre E-Mail und Telefonnummer in dieser letzten Phase der ED-Bewertung, damit Experten sich mit Ihnen in Verbindung setzen, Ihnen helfen und Sie mit einem Arzt verbinden k\u00f6nnen.<\/div>\n<hr><\/div><div id=\"field_2_40\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gppt-auto-progress-field 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_2_40'><span class='gform-field-label__text'>Land<\/span><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_40' id='input_2_40' class='large gfield_select' tabindex='107'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>- Ausw\u00e4hlen -<\/option><option value='Belgium' selected='selected'>Belgien<\/option><option value='Germany' >Deutschland<\/option><option value='Netherlands' >Niederlande<\/option><option value='Austria' >\u00d6sterreich<\/option><option value='Switzerland' >Schweiz<\/option><\/select><\/div><\/div><fieldset id=\"field_2_30\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>City\/Country<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_city has_country ginput_container_address gform-grid-row' id='input_2_30' >\n                        <span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_2_30_3_container' >\n                                    <input type='text' name='input_30.3' id='input_2_30_3' value='216.73.217.31' tabindex='109'   aria-required='true'   autocomplete=\"address-level2\" \/>\n                                    <label for='input_2_30_3' id='input_2_30_3_label' class='gform-field-label gform-field-label--type-sub '>Stadt<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_30.4' id='input_2_30_4' value='216.73.217.31'\/><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_2_30_6_container' >\n                                        <select name='input_30.6' id='input_2_30_6' tabindex='111'  aria-required='true'   autocomplete=\"country-name\" ><option value='' ><\/option><option value='AF' >Afghanistan<\/option><option value='ZA' >Afrique du Sud<\/option><option value='AL' >Albanie<\/option><option value='DZ' >Alg\u00e9rie<\/option><option value='DE' >Allemagne<\/option><option value='AD' >Andorre<\/option><option value='AO' >Angola<\/option><option value='AI' >Anguilla<\/option><option value='AQ' >Antarctique<\/option><option value='AG' >Antigua-et-Barbuda<\/option><option value='SA' >Arabie Saoudite<\/option><option value='AR' >Argentine<\/option><option value='AM' >Arm\u00e9nie<\/option><option value='AW' >Aruba<\/option><option value='AU' >Australie<\/option><option value='AT' >Autriche<\/option><option value='AZ' >Azerba\u00efdjan<\/option><option value='BS' >Bahamas<\/option><option value='BH' >Bahre\u00efn<\/option><option value='BD' >Bangladesh<\/option><option value='BY' >Belarus<\/option><option value='BE' >Belgique<\/option><option value='BZ' >Belize<\/option><option value='BJ' >B\u00e9nin<\/option><option value='BM' >Bermudes<\/option><option value='BT' >Bhoutan<\/option><option value='BO' >Bolivie<\/option><option value='BQ' >Bonaire, Saint-Eustache et Saba<\/option><option value='BA' >Bosnie-Herz\u00e9govine<\/option><option value='BW' >Botswana<\/option><option value='BR' >Br\u00e9sil<\/option><option value='BN' >Brunei Darussalam<\/option><option value='BG' >Bulgarie<\/option><option value='BF' >Burkina Faso<\/option><option value='BI' >Burundi<\/option><option value='KH' >Cambodge<\/option><option value='CM' >Cameroun<\/option><option value='CA' >Canada<\/option><option value='CV' >Cap-Vert<\/option><option value='CL' >Chili<\/option><option value='CN' >Chine<\/option><option value='CY' >Chypre<\/option><option value='CO' >Colombie<\/option><option value='KM' >Comores<\/option><option value='CG' >Congo<\/option><option value='KR' >Cor\u00e9e (R\u00e9publique de)<\/option><option value='KP' >Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)<\/option><option value='CR' >Costa Rica<\/option><option value='CI' >C\u00f4te d\u2019Ivoire<\/option><option value='HR' >Croatie<\/option><option value='CU' >Cuba<\/option><option value='CW' >Cura\u00e7ao<\/option><option value='DK' >Danemark<\/option><option value='DJ' >Djibouti<\/option><option value='DM' >Dominique<\/option><option value='EG' >\u00c9gypte<\/option><option value='AE' >\u00c9mirats arabes unis<\/option><option value='EC' >\u00c9quateur<\/option><option value='ER' >\u00c9rythr\u00e9e<\/option><option value='ES' >Espagne<\/option><option value='EE' >Estonie<\/option><option value='SZ' >Eswatini<\/option><option value='PS' >\u00c9tat palestinien<\/option><option value='US' >\u00c9tats-Unis<\/option><option value='ET' >\u00c9thiopie<\/option><option value='RU' >F\u00e9d\u00e9ration Russe<\/option><option value='FJ' >Fidji<\/option><option value='FI' >Finlande<\/option><option value='FR' >France<\/option><option value='GA' >Gabon<\/option><option value='GM' >Gambie<\/option><option value='GE' >G\u00e9orgie<\/option><option value='GS' >G\u00e9orgie du Sud et \u00celes Sandwich du Sud<\/option><option value='GH' >Ghana<\/option><option value='GI' >Gibraltar<\/option><option value='GR' >Gr\u00e8ce<\/option><option value='GD' >Grenade<\/option><option value='GL' >Groenland<\/option><option value='GP' >Guadeloupe<\/option><option value='GU' >Guam<\/option><option value='GT' >Guatemala<\/option><option value='GG' >Guernsey<\/option><option value='GN' >Guin\u00e9e<\/option><option value='GQ' >Guin\u00e9e \u00e9quatoriale<\/option><option value='GW' >Guin\u00e9e-Bissau<\/option><option value='GF' >Guyane<\/option><option value='GY' >Guyane<\/option><option value='HT' >Ha\u00efti<\/option><option value='HN' >Honduras<\/option><option value='HK' >Hong Kong<\/option><option value='HU' >Hongrie<\/option><option value='BV' >\u00cele Bouvet<\/option><option value='CX' >\u00cele Christmas<\/option><option value='IM' >\u00cele de Man<\/option><option value='MU' >\u00cele Maurice<\/option><option value='NF' >\u00cele Norfolk<\/option><option value='AX' >\u00celes \u00c5land<\/option><option value='KY' >\u00celes Cayman<\/option><option value='CC' >\u00celes Cocos<\/option><option value='CK' >\u00celes Cook<\/option><option value='SJ' >\u00celes de Svalbard et Jan Mayen<\/option><option value='FK' >\u00celes Falkland<\/option><option value='FO' >\u00celes F\u00e9ro\u00e9<\/option><option value='HM' >\u00celes Heard et McDonald<\/option><option value='MP' >\u00celes Mariannes du Nord<\/option><option value='MH' >\u00celes Marshall<\/option><option value='UM' >\u00celes mineures am\u00e9ricaines<\/option><option value='PN' >\u00celes Pitcairn<\/option><option value='SB' >\u00celes Salomon<\/option><option value='TC' >\u00celes Turques et Ca\u00efques<\/option><option value='VI' >\u00celes Vierges am\u00e9ricaines<\/option><option value='VG' >\u00celes Vierges britanniques<\/option><option value='IN' >Inde<\/option><option value='ID' >Indon\u00e9sie<\/option><option value='IQ' >Irak<\/option><option value='IR' >Iran<\/option><option value='IE' >Irlande<\/option><option value='IS' >Islande<\/option><option value='IL' >Isra\u00ebl<\/option><option value='IT' >Italie<\/option><option value='JM' >Jama\u00efque<\/option><option value='JP' >Japon<\/option><option value='JE' >Jersey<\/option><option value='JO' >Jordanie<\/option><option value='KZ' >Kazakhstan<\/option><option value='KE' >Kenya<\/option><option value='KG' >Kirghizistan<\/option><option value='KI' >Kiribati<\/option><option value='KW' >Kowe\u00eft<\/option><option value='BB' >La Barbade<\/option><option value='RE' >La R\u00e9union<\/option><option value='LS' >Lesotho<\/option><option value='LV' >Lettonie<\/option><option value='LB' >Liban<\/option><option value='LR' >Liberia<\/option><option value='LY' >Libye<\/option><option value='LI' >Liechtenstein<\/option><option value='LT' >Lituanie<\/option><option value='LU' >Luxembourg<\/option><option value='MO' >Macao<\/option><option value='MK' >Mac\u00e9doine du Nord<\/option><option value='MG' >Madagascar<\/option><option value='MY' >Malaisie<\/option><option value='MW' >Malawi<\/option><option value='MV' >Maldives<\/option><option value='ML' >Mali<\/option><option value='MT' >Malte<\/option><option value='MA' >Maroc<\/option><option value='MQ' >Martinique<\/option><option value='MR' >Mauritanie<\/option><option value='YT' >Mayotte<\/option><option value='MX' >Mexique<\/option><option value='FM' >Micron\u00e9sie<\/option><option value='MD' >Moldavie<\/option><option value='MC' >Monaco<\/option><option value='MN' >Mongolie<\/option><option value='ME' >Mont\u00e9n\u00e9gro<\/option><option value='MS' >Montserrat<\/option><option value='MZ' >Mozambique<\/option><option value='MM' >Myanmar<\/option><option value='NA' >Namibie<\/option><option value='NR' >Nauru<\/option><option value='NP' >N\u00e9pal<\/option><option value='NI' >Nicaragua<\/option><option value='NE' >Niger<\/option><option value='NG' >Nig\u00e9ria<\/option><option value='NU' >Niu\u00e9<\/option><option value='NO' >Norv\u00e8ge<\/option><option value='NC' >Nouvelle-Cal\u00e9donie<\/option><option value='NZ' >Nouvelle-Z\u00e9lande<\/option><option value='OM' >Oman<\/option><option value='UG' >Ouganda<\/option><option value='UZ' >Ouzb\u00e9kistan<\/option><option value='PK' >Pakistan<\/option><option value='PW' >Palau<\/option><option value='PA' >Panama<\/option><option value='PG' >Papouasie-Nouvelle-Guin\u00e9e<\/option><option value='PY' >Paraguay<\/option><option value='NL' >Pays-Bas<\/option><option value='PE' >P\u00e9rou<\/option><option value='PH' >Philippines<\/option><option value='PL' >Pologne<\/option><option value='PF' >Polyn\u00e9sie fran\u00e7aise<\/option><option value='PR' >Porto Rico<\/option><option value='PT' >Portugal<\/option><option value='QA' >Qatar<\/option><option value='SY' >R\u00e9publique arabe syrienne<\/option><option value='CF' >R\u00e9publique centrafricaine<\/option><option value='CD' >R\u00e9publique d\u00e9mocratique du Congo<\/option><option value='LA' >R\u00e9publique d\u00e9mocratique populaire du Laos<\/option><option value='DO' >R\u00e9publique Dominicaine<\/option><option value='CZ' >R\u00e9publique Tch\u00e8que<\/option><option value='RO' >Roumanie<\/option><option value='GB' >Royaume-Uni<\/option><option value='RW' >Rwanda<\/option><option value='EH' >Sahara occidental<\/option><option value='BL' >Saint Barth\u00e9lemy<\/option><option value='MF' >Saint Martin<\/option><option value='PM' >Saint Pierre et Miquelon<\/option><option value='KN' >Saint-Christophe-et-Nevis<\/option><option value='SM' >Saint-Marin<\/option><option value='VA' >Saint-Si\u00e8ge<\/option><option value='VC' >Saint-Vincent-et-les Grenadines<\/option><option value='SH' >Sainte-H\u00e9l\u00e8ne, Ascension et Tristan da Cunha<\/option><option value='LC' >Sainte-Lucie<\/option><option value='SV' >Salvador<\/option><option value='WS' >Samoa<\/option><option value='AS' >Samoa am\u00e9ricaines<\/option><option value='ST' >Sao Tom\u00e9 et Principe<\/option><option value='SN' >S\u00e9n\u00e9gal<\/option><option value='RS' >Serbie<\/option><option value='SC' >Seychelles<\/option><option value='SL' >Sierra Leone<\/option><option value='SG' >Singapour<\/option><option value='SX' >Sint Maarten<\/option><option value='SK' >Slovaquie<\/option><option value='SI' >Slov\u00e9nie<\/option><option value='SO' >Somalie<\/option><option value='SD' >Soudan<\/option><option value='SS' >Soudan du Sud<\/option><option value='LK' >Sri Lanka<\/option><option value='SE' >Su\u00e8de<\/option><option value='CH' >Suisse<\/option><option value='SR' >Suriname<\/option><option value='TJ' >Tadjikistan<\/option><option value='TW' >Ta\u00efwan<\/option><option value='TZ' >Tanzanie (R\u00e9publique-Unie de)<\/option><option value='TD' >Tchad<\/option><option value='TF' >Terres Australes Fran\u00e7aises<\/option><option value='IO' >Territoire britannique de l\u2019oc\u00e9an Indien<\/option><option value='TH' >Tha\u00eflande<\/option><option value='TL' >Timor oriental<\/option><option value='TG' >Togo<\/option><option value='TK' >Tokelau<\/option><option value='TO' >Tonga<\/option><option value='TT' >Trinit\u00e9 et Tobago<\/option><option value='TN' >Tunisie<\/option><option value='TM' >Turkm\u00e9nistan<\/option><option value='TR' >Turquie<\/option><option value='TV' >Tuvalu<\/option><option value='UA' >Ukraine<\/option><option value='UY' >Uruguay<\/option><option value='VU' >Vanuatu<\/option><option value='VE' >Venezuela<\/option><option value='VN' >Vietnam<\/option><option value='WF' >Wallis et Futuna<\/option><option value='YE' >Y\u00e9men<\/option><option value='ZM' >Zambie<\/option><option value='ZW' >Zimbabwe<\/option><\/select>\n                                        <label for='input_2_30_6' id='input_2_30_6_label' class='gform-field-label gform-field-label--type-sub '>Land<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><div class='gfield_description' id='gfield_description_2_30'>Warum? Wir bitten um Ihre E-Mail und Telefonnummer in dieser letzten Phase der ED-Bewertung, damit unsere Mitarbeiter Sie kontaktieren und allgemeine Informationen bereitstellen k\u00f6nnen.\n<\/div><\/fieldset><div id=\"field_2_6\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_calculation field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_6'><span class='gform-field-label__text'>Total<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_6' id='input_2_6' type='text' step='any'   value='' class='large gform-text-input-reset' tabindex='112' readonly=\"readonly\"    aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_2_35\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gppt-auto-progress-field field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_35'><span class='gform-field-label__text'>Date of Lead<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_2_35'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_35'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='113' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_2_35' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_2_35' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_2_35' aria-label='Date of Lead: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_2_36\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gppt-auto-progress-field field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_36'><span class='gform-field-label__text'>Condition<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_2_36' class='large gfield_select' tabindex='114'    aria-invalid=\"false\" ><option value='Erectile Dysfunction' >Erectile Dysfunction<\/option><option value='Urinary Incontinence' >Urinary Incontinence<\/option><option value='Testicular Replacement' >Testicular Replacement<\/option><\/select><\/div><\/div><div id=\"field_2_37\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gppt-auto-progress-field field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.\"><\/i><span>Ce champ est masqu\u00e9 lorsque l\u2018on voit le formulaire.<\/span><\/div><label class='gfield_label gform-field-label' for='input_2_37'><span class='gform-field-label__text'>Lead Source<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_37' id='input_2_37' class='large gfield_select' tabindex='115'    aria-invalid=\"false\" ><option value='Form' selected='selected'>Form<\/option><option value='Whatsapp' >Whatsapp<\/option><option value='Phone' >Phone<\/option><option value='Facebook' >Facebook<\/option><option value='Instagram' >Instagram<\/option><\/select><\/div><\/div><fieldset id=\"field_2_31\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gppt-auto-progress-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Zustimmung<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_31.1' id='input_2_31_1' type='checkbox' value='1' tabindex='116'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_31_1' ><span class='gform-field-label__text'>Ich akzeptiere die <a href=\"https:\/\/www.penisprothese.com\/fr\/evaluation-ed\/#modal-example\">Datenschutzinformationen f\u00fcr das Informationsgespr\u00e4ch<\/a>.<\/span><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/label><input type='hidden' name='input_31.2' value='Ich akzeptiere die &lt;a href=&quot;https:\/\/www.penisprothese.com\/fr\/evaluation-ed\/#modal-example&quot;&gt;Datenschutzinformationen f\u00fcr das Informationsgespr\u00e4ch&lt;\/a&gt;.' class='gform_hidden' \/><input type='hidden' name='input_31.3' value='7' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_2_42\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gppt-auto-progress-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Zustimmung<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_42.1' id='input_2_42_1' type='checkbox' value='1' tabindex='117'  aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_2_42_1' ><span class='gform-field-label__text'>Ich akzeptiere die <a href=\"https:\/\/w.rigicon.com\/privacy-policy\" rel=\"nofollow noreffer\" target=\"_blank\">Datenschutzerkl\u00e4rung<\/a> | <a href=\"https:\/\/w.rigicon.com\/terms-of-use\" rel=\"nofollow noreffer\" target=\"_blank\">Allgemeine Gesch\u00e4ftsbedingungen<\/a>.<\/span><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/label><input type='hidden' name='input_42.2' value='Ich akzeptiere die &lt;a 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