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64V185L564.8 231.5C572.8 238.5 576.9 246.5 575.8 255.5C575.8 273.5 560.8 287.6 543.8 287.6L511.8 287.6z"></path><title xmlns="">Home</title></svg></span></a> <meta itemprop="name" content="Home" /> <meta itemprop="position" content="1" /> </li> <li class="breadcrumb-item" itemprop="itemListElement" itemscope itemtype="http://schema.org/ListItem"> <a href="/en-de/products/" itemprop="item" class="breadcrumb-item-link"><span itemprop="name">Products</span></a> <meta itemprop="position" content="2" /> </li> <li class="breadcrumb-item" itemprop="itemListElement" itemscope itemtype="http://schema.org/ListItem"> <span itemprop="name" aria-current="page" class="breadcrumb-item-current-page">Medical Data Collection</span> <meta itemprop="position" content="3" /> </li> </ol> </nav> </div> </div> </section> <div class="container"> <div class="column-left w-full text-center over-dark"> <div class="caption"> <p class="eyebrow"> Bodily Injury Claims Management </p> <h1 class="h-1" > Medical Data Collection </h1> <div class="score-hero-body"> <!-- XhtmlString.cshtml Display Template Start --> <p>Risk management requires data. Receive all relevant medical information from medical reports, certificates and questionnaires with a well-founded assessment for the efficient settlement of bodily injury claims.</p> <!-- XhtmlString.cshtml Display Template End --> </div> <div class="score-call-to-action"> <a href="/en-de/products/medical-data-collection/#contact" target="_self" class="score-button verisk-button primary md" title="Contact us" > <div class="inner-content-wrapper"> <span class="button-title">Contact us<span class="button-svg-wrapper"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512" class="icon"> <path fill="#000000" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"> </path> </svg> </span> </span> </div> </a> </div> </div> </div> </div> </div> </div> <div class="[ grid__item grid__item__full ] [ full-bleed ] " id="block-115370"> <section class="score-stripe flexible-stripe no-bg-image-on-mobile bg-default " style="" data-epi-type="content"> <div class="container justify-center"> <div class="w-full"> <div class="section-header justify-center"> <H2 class=""> The direct line to medical reports </H2> <div class="subtitle rich-text justify-center"> <!-- XhtmlString.cshtml Display Template Start --> <p>To settle bodily injury claims, medical data from doctors and hospitals are required. However, obtaining this data is time-consuming. We obtain medical reports and individual questionnaires to support and prepare the claims settlement.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> </div> </div> </section> </div> <div class="card-stripe-container [ grid__item grid__item__full ] [ full-bleed ] bg-default columns-three" id="block-115371" > <section class="score-stripe slim-no-image-cards no-bg-image-on-mobile " style="" data-epi-type="content"> <div class="pagination-target"></div> <div class="container justify-center"> <div class="w-full"> <div class="section-header justify-center"> <H2 class=""> Optimise the procurement and assessment of medical records </H2> <div class="subtitle rich-text justify-center"> <!-- XhtmlString.cshtml Display Template Start --> <p>We summarise the relevant case-related data from medical records – enriched with medical and legal expertise. This supports triage and risk assessment. As a result, all important information are available to the claims handlers in a clear, standardised and quality-assured manner.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> <div class="content-area justify-center"> <div class="card-container stripe-card-column"> <div class="score-card primary slim slim-without-image verisk-default featured bg-primary-radical-blue" id="block-115373"> <div class="caption"> <H2 class="card__title"> Fast access to medical data </H2> <div class="score-card-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>We obtain medical reports, certificates and questionnaires and take care of correspondence with doctors and hospitals – so that you have time for more complex tasks.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> </div> </div> </div> <div class="card-container stripe-card-column"> <div class="score-card primary slim slim-without-image verisk-default featured bg-primary-radical-blue" id="block-115400"> <div class="caption"> <H2 class="card__title"> Relief for claims handlers and time savings </H2> <div class="score-card-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>A clear and compact summary of the medical data is available digitally – for less administrative effort and quick decisions.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> </div> </div> </div> <div class="card-container stripe-card-column"> <div class="score-card primary slim slim-without-image verisk-default featured bg-primary-radical-blue" id="block-115401"> <div class="caption"> <H2 class="card__title"> Risk management and triage </H2> <div class="score-card-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>Medical and legal assessments facilitate the prioritization of cases, support the early identification of potential risks and enable active case management.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> </div> </div> </div> </div> </div> </div> <div class="blog-pagination"> </div> </section> </div> <div class="[ grid__item grid__item__full ] [ full-bleed ]"> <section style="" class="section-hero-block-container no-bg-image-on-mobile bg- bg-alt-white-3 circular-image"> <div class="container justify-center"> <div class="w-full"> <div class="content-area"> <div class="section-hero-block"> <div class="page-layout w-7col"> <div class="score-section-hero"> <h2 class=""> How data collection works </h2> <div class="score-hero-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <ul> <li>Data protection compliant procurement</li> <li>Reminder service after resubmission</li> <li>Extraction of structured data / coding</li> <li>Read transcript and compact summary</li> <li>Medical assessment of the claim</li> <li>Legal assessment (e.g. recommendation for compensation for pain and suffering)</li> </ul> <!-- XhtmlString.cshtml Display Template End --> </div> </div> </div> </div> <div class="page-layout image-wrapper w-5col"> <div class="score-section-hero"> <h2 class=""> How data collection works </h2> </div> <img src="/4a5fbc/contentassets/285bc64c5ff646fb8757b8e57a1af42b/woman-with-headset-typing-at-computer.jpg/_croppings/gray-scarf-round.jpg" alt="Woman With Headset Typing At Computer " loading="lazy" class="score-image "> </div> </div> </div> </div> </div> </section> </div> <div class="[ grid__item grid__item__full ] [ full-bleed ]"> <section style="" class="section-hero-block-container no-bg-image-on-mobile media-left bg- circular-image"> <div class="container justify-center"> <div class="w-full"> <div class="content-area"> <div class="section-hero-block"> <div class="page-layout w-7col"> <div class="score-section-hero"> <h2 class=""> Where we support you </h2> <div class="score-hero-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <ul> <li>Motor liability insurance</li> <li>General liability insurance</li> <li>Hospital and doctors' liability insurance</li> <li>Private accident insurance</li> <li>Life insurance/occupational disability insurance</li> </ul> <!-- XhtmlString.cshtml Display Template End --> </div> </div> </div> </div> <div class="page-layout image-wrapper w-5col"> <div class="score-section-hero"> <h2 class=""> Where we support you </h2> </div> <img src="/4a7dc1/contentassets/94175e637d324ca9a4683e05dcf2d455/two-men-reviewing-laptop.jpg/_croppings/gray-scarf-round.jpg" alt="Two Men Reviewing Laptop " loading="lazy" class="score-image "> </div> </div> </div> </div> </div> </section> </div> <div class="[ grid__item grid__item__full ] [ full-bleed ]"> <div class="testimonial-carousel contain bg-primary-global-blue " style="background-image: url('');" id="block-115393"> <div class="container"> <div class="carousel__swiper"> <div class="swiper"> <div class="swiper-wrapper"><div class="swiper-slide "> <div class="score-card testimonial-card featured "> <div class="caption"> <div class="score-card-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>The team ensures that all relevant medical documents are obtained extremely quickly and competently. Our claims handlers also receive orientation values for negotiations on compensation for pain and suffering and greater certainty in risk assessment. In this way, they can identify injury risks more quickly and set more targeted intervention points.</p> <p>The result: fast processing times, rapid claims settlement and lower costs.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> <div class="testimonial-personal-details"> <h4 >Roger Schmitt</h4> <p >LVM</p> <p >Head of Motor Claims Management</p> </div> </div> </div> </div></div> <div class="swiper-pagination"></div> <a aria-disabled="false" aria-label="Previous Slide" class="score-button verisk-button false default secondary md swiper-button-prev" rel="noreferrer" target="_self"><div class="inner-content-wrapper"><span class="button-title"><span class="button-svg-wrapper"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512" class="icon"> <path fill="#000000" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"> </path> </svg></span></span></div></a> <a aria-disabled="false" aria-label="Next Slide" class="score-button verisk-button false default secondary md swiper-button-next swiper-button-disabled" rel="noreferrer" target="_self"><div class="inner-content-wrapper"><span class="button-title"><span class="button-svg-wrapper"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512" class="icon"> <path fill="#000000" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"> </path> </svg></span></span></div></a> </div> </div> </div> </div> </div> <div class="[ grid__item grid__item__full ] [ full-bleed ]"> <section style="background-image: url('');" class="section-hero-block-container no-bg-image-on-mobile bg- bg-alt-white-3 no-media"> <div class="container justify-center"> <div class="w-full"> <div class="content-area"> <div class="section-hero-block"> <div class="page-layout w-8col"> <div class="score-section-hero"> <h2 class=""> Reimagine the collection and assessment of medical records now! </h2> <div class="score-hero-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>Download the product flyer with all information at a glance. </p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> </div> </div> <div class="page-layout w-4col"> <div class="score-section-hero"> <div class="score-call-to-action"> <a href="/4a7120/siteassets/global/de-de/die-beschaffung-und-einschatzung-von-medizinischen-berichten-optimieren.pdf" target="_blank" class="score-button verisk-button primary md" title="Learn more" > <div class="inner-content-wrapper"> <span class="button-title">Learn more<span class="button-svg-wrapper"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512" class="icon"> <path fill="#000000" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"> </path> </svg> </span> </span> </div> </a> </div> </div> </div> </div> </div> </div> </div> </section> </div> <div class="card-stripe-container [ grid__item grid__item__full ] [ full-bleed ] bg-default columns-two" id="block-115377" > <section class="score-stripe image-cards no-bg-image-on-mobile " style="" data-epi-type="content"> <div class="pagination-target"></div> <div class="container justify-center"> <div class="w-full"> <div class="section-header justify-center"> <H2 class=""> Facts and figures </H2> </div> <div class="content-area justify-center"> <div class="card-container stripe-card-column"> <div class="score-card primary horizontal center product no-borders featured " id="block-115379"> <div class="image-wrapper"> <div class="image-wrapper-sub"> <img src="/4a24e0/contentassets/bc4ca01f80744a4294878260606a1329/doctor.svg" loading="lazy" class="score-image img-fluid" alt="Doctor"> </div> </div> <div class="caption"> <H2 class="card__title"> 1.000.000+<br>reports collected </H2> </div> </div> </div> <div class="card-container stripe-card-column"> <div class="score-card primary horizontal center product no-borders featured " id="block-115408"> <div class="image-wrapper"> <div class="image-wrapper-sub"> <img src="/4a24f0/contentassets/d7064086e67a48319248b6a958e786db/document-configure.svg" loading="lazy" class="score-image img-fluid" alt="Document Configure "> </div> </div> <div class="caption"> <H2 class="card__title"> 200.000+<br>doctors in continuously updated database </H2> </div> </div> </div> </div> </div> </div> <div class="blog-pagination"> </div> </section> </div> <div class="card-stripe-container [ grid__item grid__item__full ] [ full-bleed ] bg-default columns-three" id="block-115386" > <section class="score-stripe standard-cards no-bg-image-on-mobile " style="" data-epi-type="content"> <div class="pagination-target"></div> <div class="container justify-center"> <div class="w-full"> <div class="section-header justify-center"> <H2 class=""> Reimagine your claims management </H2> <div class="subtitle rich-text justify-center"> <!-- XhtmlString.cshtml Display Template Start --> <p>Optimise the entire claims management process with our full suite of solutions.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> <div class="content-area justify-center"> <div class="card-container stripe-card-column"> <div class="score-card primary horizontal standard featured" id=""> <div class="image-wrapper"> <a href="/en-de/products/medical-invoice-check/" aria-label="Rely on experts for a professional and thorough invoice check" target="_self"> <img src="/4a78a0/contentassets/46752f82f52d46488935614c08bc3263/medical-invoice-check-computer.jpg/_croppings/product-detail-page-standard-card.jpg" loading="lazy" class="score-image img-fluid" alt="Medical Invoice Check Computer "> </a> </div> <div class="caption"> <a href="/en-de/products/medical-invoice-check/" alt="Rely on experts for a professional and thorough invoice check" target="_self"> <H4 class="card__title"> Rely on experts for a professional and thorough invoice check </H4> </a> <div class="score-card-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>By systematically reviewing medical invoices for bodily injury claims, we enable an objective assessment of risks and potential reductions in claims and benefits settlement – as your medical back office.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> <div class="score-call-to-action" > <a aria-label="Learn about Medical Invoice Check" class="score-button verisk-button score-button verisk-button tertiary md" href="/en-de/products/medical-invoice-check/" rel="noreferrer" target="_self"><div class="inner-content-wrapper"><span class="button-title">Learn about Medical Invoice Check<span class="button-svg-wrapper"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512" class="icon"> <path fill="#000000" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"> </path> </svg></span></span></div></a> </div> </div> </div> </div> <div class="card-container stripe-card-column"> <div class="score-card primary horizontal standard featured" id=""> <div class="image-wrapper"> <a href="/en-de/products/medical-expert-assessments/" aria-label="Making informed decisions based on medical assessments" target="_self"> <img src="/4a72f8/contentassets/a03544e04b31445591dc782cdaa34627/tablet-and-laptop-on-table-with-stethoscope.jpg/_croppings/product-detail-page-standard-card.jpg" loading="lazy" class="score-image img-fluid" alt="Tablet And Laptop On Table With Stethoscope "> </a> </div> <div class="caption"> <a href="/en-de/products/medical-expert-assessments/" alt="Making informed decisions based on medical assessments" target="_self"> <H4 class="card__title"> Making informed decisions based on medical assessments </H4> </a> <div class="score-card-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>If your medical and care expertise reaches its limits, we offer and arrange any form of medical assessment – whether on the basis of files or with a physical examination.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> <div class="score-call-to-action" > <a aria-label="Learn about Medical Assessments" class="score-button verisk-button score-button verisk-button tertiary md" href="/en-de/products/medical-expert-assessments/" rel="noreferrer" target="_self"><div class="inner-content-wrapper"><span class="button-title">Learn about Medical Assessments<span class="button-svg-wrapper"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512" class="icon"> <path fill="#000000" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"> </path> </svg></span></span></div></a> </div> </div> </div> </div> <div class="card-container stripe-card-column"> <div class="score-card primary horizontal standard featured" id=""> <div class="image-wrapper"> <a href="/en-de/products/claims-benefits-settlement/" aria-label="Let specialists settle your claims efficiently and expertly" target="_self"> <img src="/4a66d6/contentassets/d5c0bcdbd3c84844a7f506088db7b269/row-of-customer-service-workers-with-headsets.jpg/_croppings/product-detail-page-standard-card.jpg" loading="lazy" class="score-image img-fluid" alt="Row Of Customer Service Workers With Headsets "> </a> </div> <div class="caption"> <a href="/en-de/products/claims-benefits-settlement/" alt="Let specialists settle your claims efficiently and expertly" target="_self"> <H4 class="card__title"> Let specialists settle your claims efficiently and expertly </H4> </a> <div class="score-card-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>Our teams of experts support the claims and benefits settlement of various insurance lines to the desired level of integration: from selective relief of certain activities to case-closing settlement of bodily injury, motor and property claims.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> <div class="score-call-to-action" > <a aria-label="Learn about Claims and Benefits Settlement" class="score-button verisk-button score-button verisk-button tertiary md" href="/en-de/products/claims-benefits-settlement/" rel="noreferrer" target="_self"><div class="inner-content-wrapper"><span class="button-title">Learn about Claims and Benefits Settlement<span class="button-svg-wrapper"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512" class="icon"> <path fill="#000000" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"> </path> </svg></span></span></div></a> </div> </div> </div> </div> <div class="card-container stripe-card-column"> <div class="score-card primary horizontal standard featured" id=""> <div class="image-wrapper"> <a href="/en-de/products/claims-agent/" aria-label="Higher productivity frees up capacity for essential activities" target="_self"> <img src="/4a7c6a/contentassets/8606e32c6c9e4454aa0b33a449bccce4/professional-reviewing-data-on-screen.jpg/_croppings/product-detail-page-standard-card.jpg" loading="lazy" class="score-image img-fluid" alt="Professional Reviewing Data On Screen "> </a> </div> <div class="caption"> <a href="/en-de/products/claims-agent/" alt="Higher productivity frees up capacity for essential activities" target="_self"> <H4 class="card__title"> Higher productivity frees up capacity for essential activities </H4> </a> <div class="score-card-body"> <div class="rich-text"> <!-- XhtmlString.cshtml Display Template Start --> <p>Smart assistants turn complex medical or legal documents into clear, structured case summaries – in just minutes.</p> <!-- XhtmlString.cshtml Display Template End --> </div> </div> <div class="score-call-to-action" > <a aria-label="Learn about Claims Agent" class="score-button verisk-button score-button verisk-button tertiary md" href="/en-de/products/claims-agent/" rel="noreferrer" target="_self"><div class="inner-content-wrapper"><span class="button-title">Learn about Claims Agent<span class="button-svg-wrapper"> <svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 320 512" class="icon"> <path fill="#000000" d="M310.6 233.4c12.5 12.5 12.5 32.8 0 45.3l-192 192c-12.5 12.5-32.8 12.5-45.3 0s-12.5-32.8 0-45.3L242.7 256 73.4 86.6c-12.5-12.5-12.5-32.8 0-45.3s32.8-12.5 45.3 0l192 192z"> </path> </svg></span></span></div></a> </div> </div> </div> </div> </div> </div> </div> <div class="blog-pagination"> </div> </section> </div> <div class="[ grid__item grid__item__full ] [ full-bleed ] " id="contact"> <section class="score-stripe flexible-stripe no-bg-image-on-mobile bg-default " style="" data-epi-type="content"> <div class="container justify-center"> <div class="w-full"> <div class="section-header justify-center"> <H2 class=""> Contact us to learn more </H2> </div> <div class="content-area justify-center"><div class=" w-8col"> <form method="post" novalidate="novalidate" data-f-metadata="" enctype="multipart/form-data" class="EPiServerForms ValidationSuccess bg-alt-white-3 expanded-form" data-f-type="form" id="0e9c223f-3878-4a09-a56d-d4b0af0aceb6"> <script type="text/javascript"> // This view acts as a rendering template to render InitScript(and server-side Form's descriptor) in FormContainerBlock's client-side for Form[0e9c223f-3878-4a09-a56d-d4b0af0aceb6]. // TECHNOTE: all serverside (paths, dynamic values) of EPiServerForms will be transfered to client side here in this section. 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required.\",\"validationCssClass\":\"ValidationRequired\",\"additionalAttributes\":{\"required\":\"\",\"aria-required\":\"true\"}}}]},{\"targetElementName\":\"__field_120087\",\"targetElementId\":\"9f43379c-1926-4a73-b6fb-ceef8fd9ad26\",\"validators\":[{\"type\":\"EPiServer.Forms.Implementation.Validation.RequiredValidator\",\"description\":null,\"model\":{\"message\":\"This field is required.\",\"validationCssClass\":\"ValidationRequired\",\"additionalAttributes\":{\"required\":\"\",\"aria-required\":\"true\"}}}]},{\"targetElementName\":\"__field_35084\",\"targetElementId\":\"b885ebd3-5ad2-422c-9af2-3811ed8d00c2\",\"validators\":[{\"type\":\"EPiServer.Forms.Samples.Implementation.Validation.RecaptchaValidator\",\"description\":null,\"model\":{\"message\":\"Invalid reCAPTCHA value, please try again.\",\"validationCssClass\":null,\"additionalAttributes\":null}}]}]"), // Steps information for driving multiple-step Forms. StepsInfo : { Steps: [{"index":0,"attachedUrl":"","dependField":null,"dependCondition":null,"isActive":true,"attachedContentLink":"","dependValue":"","elementName":"__field_","guid":"00000000-0000-0000-0000-000000000000"}] }, FieldsExcludedInSubmissionSummary: [], ElementsInfo: JSON.parse("{\"__field_35078\":{\"type\":\"EPiServer.Forms.Implementation.Elements.TextboxElementBlock\",\"friendlyName\":\"firstName\",\"customBinding\":false},\"__field_35079\":{\"type\":\"EPiServer.Forms.Implementation.Elements.TextboxElementBlock\",\"friendlyName\":\"lastName\",\"customBinding\":false},\"__field_35080\":{\"type\":\"EPiServer.Forms.Implementation.Elements.TextboxElementBlock\",\"friendlyName\":\"emailAddress\",\"customBinding\":false},\"__field_35082\":{\"type\":\"EPiServer.Forms.Implementation.Elements.TextboxElementBlock\",\"friendlyName\":\"company\",\"customBinding\":false},\"__field_35081\":{\"type\":\"EPiServer.Forms.Implementation.Elements.TextboxElementBlock\",\"friendlyName\":\"title\",\"customBinding\":false},\"__field_120087\":{\"type\":\"EPiServer.Forms.Implementation.Elements.SelectionElementBlock\",\"friendlyName\":\"country\",\"customBinding\":false},\"__field_120106\":{\"type\":\"EPiServer.Forms.Implementation.Elements.TextareaElementBlock\",\"friendlyName\":\"comments\",\"customBinding\":false},\"__field_35117\":{\"type\":\"EPiServer.Forms.Implementation.Elements.SubmitButtonElementBlock\",\"friendlyName\":\"Submit\",\"customBinding\":false}}"), DataSubmitController: "/EPiServer.Forms/DataSubmit", }; /// TECHNOTE: Calculation at FormInfo level, and these values will be static input for later processing. workingFormInfo.StepsInfo.FormHasNoStep_VirtualStepCreated=true; // this FLAG will be true, if Editor does not put any FormStep. Engine will create a virtual step, with empty GUID workingFormInfo.StepsInfo.FormHasNothing=false; // this FLAG will be true if FormContainer has no element at all workingFormInfo.StepsInfo.AllStepsAreNotLinked=true; // this FLAG will be true, if all steps all have contentLink= ="" (emptyString) })(); </script> <input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormName" value="GLB: glb-de-clm-sales-support-1257" data-f-type="hidden" autocomplete="off" /> <input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormGuid" value="0e9c223f-3878-4a09-a56d-d4b0af0aceb6" data-f-type="hidden" autocomplete="off" /> <input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormHostedPage" value="115367" data-f-type="hidden" autocomplete="off" /> <input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormLanguage" value="en-DE" data-f-type="hidden" autocomplete="off" /> <input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormCurrentStepIndex" value="0" data-f-type="hidden" autocomplete="off" /> <input type="hidden" class="Form__Element Form__SystemElement FormHidden FormHideInSummarized" name="__FormSubmissionId" value="" data-f-type="hidden" autocomplete="off" /> <div class="Form__Status"> <div role="alert" aria-live="polite" class="Form__Status__Message hide" data-f-form-statusmessage> </div> </div> <div data-f-mainbody class="Form__MainBody"> <section id="e9f8420c-adc6-4924-a86e-fdc0afc70c51" data-f-type="step" data-f-element-name="__field_" class="Form__Element FormStep Form__Element--NonData " data-f-stepindex="0" data-f-element-nondata> <!-- Each FormStep groups the elements below it til the next FormStep --> <div class=" "> <div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_35078" data-f-type="textbox"> <label for="c3d65aff-af7b-4496-aa59-65011b2a2914" class="Form__Element__Caption">First Name</label> <input name="__field_35078" id="c3d65aff-af7b-4496-aa59-65011b2a2914" type="text" class="FormTextbox__Input" aria-describedby="__field_35078_desc" placeholder="First Name" required aria-required="true" data-f-datainput autocomplete="off"/> <span class="Form__Element__ValidationError" data-f-linked-name="__field_35078" data-f-validationerror="" id="__field_35078_desc" role="alert" style="display:none"></span></div></div><div class=" "> <div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_35079" data-f-type="textbox"> <label for="b866e49a-ba5f-41c1-bffc-cafc7e7e7fee" class="Form__Element__Caption">Last Name</label> <input name="__field_35079" id="b866e49a-ba5f-41c1-bffc-cafc7e7e7fee" type="text" class="FormTextbox__Input" aria-describedby="__field_35079_desc" placeholder="Last Name" required aria-required="true" data-f-datainput autocomplete="off"/> <span class="Form__Element__ValidationError" data-f-linked-name="__field_35079" data-f-validationerror="" id="__field_35079_desc" role="alert" style="display:none"></span></div></div><div class=" "> <div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_35080" data-f-type="textbox"> <label for="33a8c375-9386-4c39-aa8b-4236bceb44ae" class="Form__Element__Caption">Business Email</label> <input name="__field_35080" id="33a8c375-9386-4c39-aa8b-4236bceb44ae" type="text" class="FormTextbox__Input" aria-describedby="__field_35080_desc" placeholder="Business Email" required aria-required="true" data-f-datainput autocomplete="off"/> <span class="Form__Element__ValidationError" data-f-linked-name="__field_35080" data-f-validationerror="" id="__field_35080_desc" role="alert" style="display:none"></span></div></div><div class=" "> <div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_35082" data-f-type="textbox"> <label for="d6c214b8-683c-4b6c-a2d8-d58ea009a64e" class="Form__Element__Caption">Company</label> <input name="__field_35082" id="d6c214b8-683c-4b6c-a2d8-d58ea009a64e" type="text" class="FormTextbox__Input" aria-describedby="__field_35082_desc" placeholder="Company" required aria-required="true" data-f-datainput autocomplete="off"/> <span class="Form__Element__ValidationError" data-f-linked-name="__field_35082" data-f-validationerror="" id="__field_35082_desc" role="alert" style="display:none"></span></div></div><div class=" "> <div class="Form__Element FormTextbox ValidationRequired" data-f-element-name="__field_35081" data-f-type="textbox"> <label for="7c6009d9-8d06-4151-9e35-1c1ebd40d9fb" class="Form__Element__Caption">Title</label> <input name="__field_35081" id="7c6009d9-8d06-4151-9e35-1c1ebd40d9fb" type="text" class="FormTextbox__Input" aria-describedby="__field_35081_desc" placeholder="Title" required aria-required="true" data-f-datainput autocomplete="off"/> <span class="Form__Element__ValidationError" data-f-linked-name="__field_35081" data-f-validationerror="" id="__field_35081_desc" role="alert" style="display:none"></span></div></div><div class=" "> <div class="Form__Element FormSelection ValidationRequired" data-f-element-name="__field_120087" data-f-type="selection"> <label for="9f43379c-1926-4a73-b6fb-ceef8fd9ad26" class="Form__Element__Caption">Country</label> <select name="__field_120087" id="9f43379c-1926-4a73-b6fb-ceef8fd9ad26" required aria-required="true" data-f-datainput aria-describedby="__field_120087_desc" autocomplete="off"> <option disabled="disabled" value=""> -- Select an option -- </option> <option value="DE" selected data-f-default-value="true" data-f-datainput>Germany</option> <option value="US" data-f-datainput>United States</option> <option value="GB" data-f-datainput>United Kingdom</option> <option value="AF" data-f-datainput>Afghanistan</option> <option value="AL" data-f-datainput>Albania</option> <option value="DZ" data-f-datainput>Algeria</option> <option value="AS" data-f-datainput>American Samoa</option> <option value="AD" data-f-datainput>Andorra</option> <option value="AO" data-f-datainput>Angola</option> <option value="AI" data-f-datainput>Anguilla</option> <option value="AQ" data-f-datainput>Antarctica</option> <option value="AG" data-f-datainput>Antigua and Barbuda</option> <option value="AR" data-f-datainput>Argentina</option> <option value="AM" data-f-datainput>Armenia</option> <option value="AW" data-f-datainput>Aruba</option> <option value="AU" data-f-datainput>Australia</option> <option value="AT" data-f-datainput>Austria</option> <option value="AZ" data-f-datainput>Azerbaijan</option> <option value="BS" data-f-datainput>Bahamas</option> <option value="BH" data-f-datainput>Bahrain</option> <option value="BD" data-f-datainput>Bangladesh</option> <option value="BB" data-f-datainput>Barbados</option> <option value="BY" data-f-datainput>Belarus</option> <option value="BE" data-f-datainput>Belgium</option> <option value="BZ" data-f-datainput>Belize</option> <option value="BJ" data-f-datainput>Benin</option> <option value="BM" data-f-datainput>Bermuda</option> <option value="BT" data-f-datainput>Bhutan</option> <option value="BO" data-f-datainput>Bolivia</option> <option value="BA" data-f-datainput>Bosnia and Herzegovina</option> <option value="BW" data-f-datainput>Botswana</option> <option value="BR" data-f-datainput>Brazil</option> <option value="IO" data-f-datainput>British Indian Ocean Territory</option> <option value="BN" data-f-datainput>Brunei Darussalam</option> <option value="BG" data-f-datainput>Bulgaria</option> <option value="BF" data-f-datainput>Burkina Faso</option> <option value="BI" data-f-datainput>Burundi</option> <option value="KH" data-f-datainput>Cambodia</option> <option value="CM" data-f-datainput>Cameroon</option> <option value="CA" data-f-datainput>Canada</option> <option value="CV" data-f-datainput>Cape Verde</option> <option value="KY" data-f-datainput>Cayman Islands</option> <option value="CF" data-f-datainput>Central African Republic</option> <option value="TD" data-f-datainput>Chad</option> <option value="CL" data-f-datainput>Chile</option> <option value="CN" data-f-datainput>China</option> <option value="CX" data-f-datainput>Christmas Island</option> <option value="CC" data-f-datainput>Cocos (Keeling) Islands</option> <option value="CO" data-f-datainput>Colombia</option> <option value="KM" data-f-datainput>Comoros</option> <option value="CG" data-f-datainput>Congo</option> <option value="CD" data-f-datainput>Congo (RD)</option> <option value="CK" data-f-datainput>Cook Islands</option> <option value="CR" data-f-datainput>Costa Rica</option> <option value="CI" data-f-datainput>Cote d'Ivoire</option> <option value="HR" data-f-datainput>Croatia</option> <option value="CU" data-f-datainput>Cuba</option> <option value="CY" data-f-datainput>Cyprus</option> <option value="CZ" data-f-datainput>Czech Republic</option> <option value="DK" data-f-datainput>Denmark</option> <option value="DJ" data-f-datainput>Djibouti</option> <option value="DM" data-f-datainput>Dominica</option> <option value="DO" data-f-datainput>Dominican Republic</option> <option value="EC" data-f-datainput>Ecuador</option> <option value="EG" data-f-datainput>Egypt</option> <option value="SV" data-f-datainput>El Salvador</option> <option value="GQ" data-f-datainput>Equatorial Guinea</option> <option value="ER" data-f-datainput>Eritrea</option> <option value="EE" data-f-datainput>Estonia</option> <option value="ET" data-f-datainput>Ethiopia</option> <option value="FK" data-f-datainput>Falkland Islands</option> <option value="FO" data-f-datainput>Faroe Islands</option> <option value="FJ" data-f-datainput>Fiji</option> <option value="FI" data-f-datainput>Finland</option> <option value="FR" data-f-datainput>France</option> <option value="GF" data-f-datainput>French Guiana</option> <option value="PF" data-f-datainput>French Polynesia</option> <option value="TF" data-f-datainput>French Southern Terr.</option> <option value="GA" data-f-datainput>Gabon</option> <option value="GM" data-f-datainput>Gambia</option> <option value="GE" data-f-datainput>Georgia</option> <option value="GH" data-f-datainput>Ghana</option> <option value="GI" data-f-datainput>Gibraltar</option> <option value="GR" data-f-datainput>Greece</option> <option value="GL" data-f-datainput>Greenland</option> <option value="GD" data-f-datainput>Grenada</option> <option value="GP" data-f-datainput>Guadeloupe</option> <option value="GU" data-f-datainput>Guam</option> <option value="GT" data-f-datainput>Guatemala</option> <option value="GN" data-f-datainput>Guinea</option> <option value="GW" data-f-datainput>Guinea-Bissau</option> <option value="GY" data-f-datainput>Guyana</option> <option value="HT" data-f-datainput>Haiti</option> <option value="HM" data-f-datainput>Heard/McDonald Isls.</option> <option value="HN" data-f-datainput>Honduras</option> <option value="HK" data-f-datainput>Hong Kong</option> <option value="HU" data-f-datainput>Hungary</option> <option value="IS" data-f-datainput>Iceland</option> <option value="IN" data-f-datainput>India</option> <option value="ID" data-f-datainput>Indonesia</option> <option value="IR" data-f-datainput>Iran</option> <option value="IQ" data-f-datainput>Iraq</option> <option value="IE" data-f-datainput>Ireland</option> <option value="IL" data-f-datainput>Israel</option> <option value="IT" data-f-datainput>Italy</option> <option value="JM" data-f-datainput>Jamaica</option> <option value="JP" data-f-datainput>Japan</option> <option value="JO" data-f-datainput>Jordan</option> <option value="KZ" data-f-datainput>Kazakhstan</option> <option value="KE" data-f-datainput>Kenya</option> <option value="KI" data-f-datainput>Kiribati</option> <option value="KP" data-f-datainput>Korea (North)</option> <option value="KR" data-f-datainput>Korea (South)</option> <option value="KW" data-f-datainput>Kuwait</option> <option value="KG" data-f-datainput>Kyrgyzstan</option> <option value="LA" data-f-datainput>Laos</option> <option value="LV" data-f-datainput>Latvia</option> <option value="LB" data-f-datainput>Lebanon</option> <option value="LS" data-f-datainput>Lesotho</option> <option value="LR" data-f-datainput>Liberia</option> <option value="LY" data-f-datainput>Libya</option> <option value="LI" data-f-datainput>Liechtenstein</option> <option value="LT" data-f-datainput>Lithuania</option> <option value="LU" data-f-datainput>Luxembourg</option> <option value="MO" data-f-datainput>Macau</option> <option value="MK" data-f-datainput>Macedonia</option> <option value="MG" data-f-datainput>Madagascar</option> <option value="MW" data-f-datainput>Malawi</option> <option value="MY" data-f-datainput>Malaysia</option> <option value="MV" data-f-datainput>Maldives</option> <option value="ML" data-f-datainput>Mali</option> <option value="MT" data-f-datainput>Malta</option> <option value="MH" data-f-datainput>Marshall Islands</option> <option value="MQ" data-f-datainput>Martinique</option> <option value="MR" data-f-datainput>Mauritania</option> <option value="MU" data-f-datainput>Mauritius</option> <option value="YT" data-f-datainput>Mayotte</option> <option value="MX" data-f-datainput>Mexico</option> <option value="FM" data-f-datainput>Micronesia</option> <option value="MD" data-f-datainput>Moldova</option> <option value="MC" data-f-datainput>Monaco</option> <option value="MN" data-f-datainput>Mongolia</option> <option value="MS" data-f-datainput>Montserrat</option> <option value="MA" data-f-datainput>Morocco</option> <option value="MZ" data-f-datainput>Mozambique</option> <option value="MM" data-f-datainput>Myanmar</option> <option value="MP" data-f-datainput>N. Mariana Isls.</option> <option value="NA" data-f-datainput>Namibia</option> <option value="NR" data-f-datainput>Nauru</option> <option value="NP" data-f-datainput>Nepal</option> <option value="NL" data-f-datainput>Netherlands</option> <option value="AN" data-f-datainput>Netherlands Antilles</option> <option value="NC" data-f-datainput>New Caledonia</option> <option value="NZ" data-f-datainput>New Zealand</option> <option value="NI" data-f-datainput>Nicaragua</option> <option value="NE" data-f-datainput>Niger</option> <option value="NG" data-f-datainput>Nigeria</option> <option value="NU" data-f-datainput>Niue</option> <option value="NF" data-f-datainput>Norfolk Island</option> <option value="NO" data-f-datainput>Norway</option> <option value="OM" data-f-datainput>Oman</option> <option value="PK" data-f-datainput>Pakistan</option> <option value="PW" data-f-datainput>Palau</option> <option value="PS" data-f-datainput>Palestinian Territory, Occupied</option> <option value="PA" 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data-f-datainput>Sao Tome/Principe</option> <option value="SA" data-f-datainput>Saudi Arabia</option> <option value="SN" data-f-datainput>Senegal</option> <option value="CS" data-f-datainput>Serbia and Montenegro</option> <option value="SC" data-f-datainput>Seychelles</option> <option value="SL" data-f-datainput>Sierra Leone</option> <option value="SG" data-f-datainput>Singapore</option> <option value="SK" data-f-datainput>Slovak Republic</option> <option value="SI" data-f-datainput>Slovenia</option> <option value="SB" data-f-datainput>Solomon Islands</option> <option value="SO" data-f-datainput>Somalia</option> <option value="ZA" data-f-datainput>South Africa</option> <option value="ES" data-f-datainput>Spain</option> <option value="LK" data-f-datainput>Sri Lanka</option> <option value="SH" data-f-datainput>St. Helena</option> <option value="PM" data-f-datainput>St. Pierre and Miquelon</option> <option value="VC" data-f-datainput>St. Vincent and Grenadines</option> <option value="SD" data-f-datainput>Sudan</option> <option value="SR" data-f-datainput>Suriname</option> <option value="SJ" data-f-datainput>Svalbard/Jan Mayen Isls.</option> <option value="SZ" data-f-datainput>Swaziland</option> <option value="SE" data-f-datainput>Sweden</option> <option value="CH" data-f-datainput>Switzerland</option> <option value="SY" data-f-datainput>Syria</option> <option value="TW" data-f-datainput>Taiwan</option> <option value="TJ" data-f-datainput>Tajikistan</option> <option value="TZ" data-f-datainput>Tanzania</option> <option value="TH" data-f-datainput>Thailand</option> <option value="TL" data-f-datainput>Timor-Leste</option> <option value="TG" data-f-datainput>Togo</option> <option value="TK" data-f-datainput>Tokelau</option> <option value="TO" data-f-datainput>Tonga</option> <option value="TT" data-f-datainput>Trinidad and Tobago</option> <option value="TN" data-f-datainput>Tunisia</option> <option value="TR" data-f-datainput>Turkey</option> <option value="TM" data-f-datainput>Turkmenistan</option> <option value="TC" data-f-datainput>Turks/Caicos Isls.</option> <option value="TV" data-f-datainput>Tuvalu</option> <option value="UM" data-f-datainput>US Minor Outlying Is.</option> <option value="UG" data-f-datainput>Uganda</option> <option value="UA" data-f-datainput>Ukraine</option> <option value="AE" data-f-datainput>United Arab Emirates</option> <option value="UY" data-f-datainput>Uruguay</option> <option value="UZ" data-f-datainput>Uzbekistan</option> <option value="VU" data-f-datainput>Vanuatu</option> <option value="VA" data-f-datainput>Vatican City</option> <option value="VE" data-f-datainput>Venezuela</option> <option value="VN" data-f-datainput>Viet Nam</option> <option value="VG" data-f-datainput>Virgin Islands (British)</option> <option value="VI" data-f-datainput>Virgin Islands (U.S.)</option> <option value="EH" data-f-datainput>Western Sahara</option> <option value="YE" data-f-datainput>Yemen</option> <option value="ZM" 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