{"id":141,"date":"2015-10-30T06:51:10","date_gmt":"2015-10-30T06:51:10","guid":{"rendered":"http:\/\/thegenius.co\/dentistry\/demo\/?page_id=141"},"modified":"2015-10-30T06:51:10","modified_gmt":"2015-10-30T06:51:10","slug":"appointment-form","status":"publish","type":"page","link":"https:\/\/typec.in\/dental-clinic\/index.php\/appointment-form\/","title":{"rendered":"Appointment Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"141\" class=\"elementor elementor-141\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b29296f elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"b29296f\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-66a53f0\" data-id=\"66a53f0\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d273f43 elementor-widget elementor-widget-heading\" data-id=\"d273f43\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.10.1 - 24-01-2023 *\/\n.elementor-heading-title{padding:0;margin:0;line-height:1}.elementor-widget-heading .elementor-heading-title[class*=elementor-size-]>a{color:inherit;font-size:inherit;line-height:inherit}.elementor-widget-heading .elementor-heading-title.elementor-size-small{font-size:15px}.elementor-widget-heading .elementor-heading-title.elementor-size-medium{font-size:19px}.elementor-widget-heading .elementor-heading-title.elementor-size-large{font-size:29px}.elementor-widget-heading .elementor-heading-title.elementor-size-xl{font-size:39px}.elementor-widget-heading .elementor-heading-title.elementor-size-xxl{font-size:59px}<\/style><h1 class=\"elementor-heading-title elementor-size-default\">Request a Dentist Appointment<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-eb05ea7 elementor-widget elementor-widget-text-editor\" data-id=\"eb05ea7\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.10.1 - 24-01-2023 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#818a91;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#818a91;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>To request an appointment, please fill out the form below.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ccef1ec elementor-widget elementor-widget-contactform7\" data-id=\"ccef1ec\" data-element_type=\"widget\" data-widget_type=\"contactform7.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"wpcf7 no-js\" id=\"wpcf7-f262-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/dental-clinic\/index.php\/wp-json\/wp\/v2\/pages\/141?simply_static_page=1009#wpcf7-f262-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"262\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.7.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f262-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"row tp-appointment-form\">\n\t<div class=\"col-md-offset-1 col-md-10\">\n\t\t<div class=\"row tp-section-clr space-block\">\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>First Name*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Last Name*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"last-name\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"last-name\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Email*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Mobile Number*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"phone-no\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"phone-no\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Gender*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-758\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-758\" value=\"Male\" checked=\"checked\" tabindex=\"\" \/><span class=\"wpcf7-list-item-label\">Male<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-758\" value=\"Female\" tabindex=\"\" \/><span class=\"wpcf7-list-item-label\">Female<\/span><\/span><\/span><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>City*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"city\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"city\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Country<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"country-687\"><select class=\"wpcf7-form-control wpcf7-select form-control\" aria-invalid=\"false\" name=\"country-687\"><option value=\"India\">India<\/option><option value=\"Canada\">Canada<\/option><option value=\"Australia\">Australia<\/option><option value=\"New Zealand\">New Zealand<\/option><\/select><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Zip Code*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"zip-code\"><input size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"zip-code\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Select Day*<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"date-137\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date form-control\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-137\" \/><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-6\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Select Time*<\/label><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"time-214\"><select class=\"wpcf7-form-control wpcf7-select form-control\" aria-invalid=\"false\" name=\"time-214\"><option value=\"Morning\">Morning<\/option><option value=\"Noon\">Noon<\/option><option value=\"Evening\">Evening<\/option><\/select><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<div class=\"form-group\">\n\t\t\t\t\t<p><label>Message<\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"your-message\"><textarea cols=\"40\" rows=\"5\" class=\"wpcf7-form-control wpcf7-textarea form-control\" aria-invalid=\"false\" name=\"your-message\"><\/textarea><\/span>\n\t\t\t\t\t<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<div class=\"col-md-12\">\n\t\t\t\t<p><input class=\"wpcf7-form-control has-spinner wpcf7-submit tp-btn-default\" type=\"submit\" value=\"Submit Application\" \/>\n\t\t\t\t<\/p>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Request a Dentist Appointment To request an appointment, please fill out the form below. First Name* Last Name* Email* Mobile Number* Gender*MaleFemale City* CountryIndiaCanadaAustraliaNew Zealand Zip Code* Select Day* Select Time* MorningNoonEvening Message<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/typec.in\/dental-clinic\/index.php\/wp-json\/wp\/v2\/pages\/141"}],"collection":[{"href":"https:\/\/typec.in\/dental-clinic\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/typec.in\/dental-clinic\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/typec.in\/dental-clinic\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/typec.in\/dental-clinic\/index.php\/wp-json\/wp\/v2\/comments?post=141"}],"version-history":[{"count":0,"href":"https:\/\/typec.in\/dental-clinic\/index.php\/wp-json\/wp\/v2\/pages\/141\/revisions"}],"wp:attachment":[{"href":"https:\/\/typec.in\/dental-clinic\/index.php\/wp-json\/wp\/v2\/media?parent=141"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}