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<label id="tfa_1-L" class="label preField reqMark" for="tfa_1">Voornaam:</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_1" name="tfa_1" value="" autocomplete="off" title="Voornaam:" class="validate-alphanum required"></div>
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<label id="tfa_12-L" class="label preField reqMark" for="tfa_12">E-mailadres</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_12" name="tfa_12" value="" autocomplete="off" title="E-mailadres" class="validate-email required"></div>
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<label id="tfa_59-L" class="label preField " for="tfa_59">E-mail tekst</label><br><div class="inputWrapper"><textarea maxlength="300" id="tfa_59" name="tfa_59" title="E-mail tekst" class=""></textarea></div>
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<label id="tfa_51-L" class="label preField reqMark" for="tfa_51">Categorie</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_51" name="tfa_51" value="contact opnemen" default="contact opnemen" maxlength="50" title="Categorie" class="required"></div>
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<label id="tfa_61-L" class="label preField reqMark" for="tfa_61">Record Type ID</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_61" name="tfa_61" value="0120J000000opbSQAQ" default="0120J000000opbSQAQ" title="Record Type ID" class="required"></div>
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<div class="oneField field-container-D     wf-acl-hidden" id="tfa_65-D">
<label id="tfa_65-L" class="label preField reqMark" for="tfa_65">Formulier_titel</label><br><div class="inputWrapper"><input aria-required="true" type="text" id="tfa_65" name="tfa_65" value="Contact farmaceutisch pakket" default="Contact farmaceutisch pakket" title="Formulier_titel" class="required"></div>
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<label id="tfa_63-L" class="label preField " for="tfa_63">Subjectline bevestigingsmail (bij leeg veld wordt default Marketing Cloud waarde gebruikt)</label><br><div class="inputWrapper"><textarea maxlength="300" id="tfa_63" name="tfa_63" title="Subjectline bevestigingsmail (bij leeg veld wordt default Marketing Cloud waarde gebruikt)" class=""></textarea></div>
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  <p class="supportInfo" >
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Farmaceutisch pakket                                                                                

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