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<!DOCTYPE html><html lang="de"><head><meta charset="utf-8">
<link rel="stylesheet" href="https://www.drogentest-online.de/wp-content/themes/drogentest-online/assets/css/main.css">
<style>body{margin:0;background:#eef2f8;font-family:Inter,sans-serif}.dgt-sb-modal{position:static!important}.dgt-sb-modal-back{display:none}</style></head><body class="dgt-site">
<div id="dgt-sb-suggest" class="dgt-sb-modal" role="dialog" aria-modal="true" aria-labelledby="dgt-sb-suggest-t">
<div class="dgt-sb-modal-back" data-sb-close></div>
<div class="dgt-sb-modal-box">
<div class="dgt-sb-modal-head">
<h2 id="dgt-sb-suggest-t">Beratungsstelle vorschlagen</h2>
<button type="button" class="dgt-sb-modal-x" data-sb-close aria-label="Schließen">×</button>
</div>
<form class="dgt-sb-form" id="dgt-sb-suggest-form">
<p class="dgt-sb-form-intro">Kennst du eine Suchtberatungsstelle, die hier fehlt? Trag die Daten ein – wir prüfen den Vorschlag.</p>
<label>Name der Einrichtung *<input type="text" name="name" required></label>
<label class="dgt-sb-autocomplete">Straße & Hausnummer
<input type="text" name="street" autocomplete="off" placeholder="Tippen für Adressvorschläge …">
<ul class="dgt-sb-suggestions"></ul>
</label>
<div class="dgt-sb-form-row">
<label>PLZ<input type="text" name="zip" inputmode="numeric"></label>
<label>Stadt *<input type="text" name="city" required></label>
</div>
<label>Bundesland
<select name="bundesland">
<option value="">Bitte wählen</option>
<option value="Baden-Württemberg">Baden-Württemberg</option>
<option value="Bayern">Bayern</option>
<option value="Berlin">Berlin</option>
<option value="Brandenburg">Brandenburg</option>
<option value="Bremen">Bremen</option>
<option value="Hamburg">Hamburg</option>
<option value="Hessen">Hessen</option>
<option value="Mecklenburg-Vorpommern">Mecklenburg-Vorpommern</option>
<option value="Niedersachsen">Niedersachsen</option>
<option value="Nordrhein-Westfalen">Nordrhein-Westfalen</option>
<option value="Rheinland-Pfalz">Rheinland-Pfalz</option>
<option value="Saarland">Saarland</option>
<option value="Sachsen">Sachsen</option>
<option value="Sachsen-Anhalt">Sachsen-Anhalt</option>
<option value="Schleswig-Holstein">Schleswig-Holstein</option>
<option value="Thüringen">Thüringen</option>
</select>
</label>
<div class="dgt-sb-form-row">
<label>Telefon<input type="text" name="phone"></label>
<label>E-Mail der Stelle<input type="email" name="email"></label>
</div>
<label>Website<input type="url" name="web" placeholder="https://…"></label>
<label>Anmerkung<textarea name="note" rows="2"></textarea></label>
<label>Deine E-Mail (für Rückfragen)<input type="email" name="submitter"></label>
<input type="text" name="website_hp" class="dgt-sb-hp" tabindex="-1" autocomplete="off" aria-hidden="true">
<div class="dgt-sb-form-foot">
<button type="button" class="btn dgt-btn dgt-btn-ghost" data-sb-close>Abbrechen</button>
<button type="submit" class="btn dgt-btn dgt-btn-primary">Vorschlag senden</button>
</div>
<p class="dgt-sb-form-msg" role="status" aria-live="polite"></p>
</form>
</div>
</div>
<!-- Melde-Modal -->
</body></html>