{"id":382,"date":"2022-06-14T16:02:43","date_gmt":"2022-06-14T16:02:43","guid":{"rendered":"https:\/\/prothomestacare.com\/prothomesta-clinic\/?page_id=382"},"modified":"2022-06-14T17:15:05","modified_gmt":"2022-06-14T17:15:05","slug":"appointment-form","status":"publish","type":"page","link":"https:\/\/prothomestacare.com\/prothomesta-clinic\/appointment-form\/","title":{"rendered":"Appointment Form"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f384-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"384\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/prothomesta-clinic\/wp-json\/wp\/v2\/pages\/382#wpcf7-f384-o1\" method=\"post\" class=\"wpcf7-form init cf7mls-no-scroll cf7mls-no-moving-animation\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"384\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f384-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"row g-3\">\n\t<div class=\"col-12\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Patient Name*\" value=\"\" type=\"text\" name=\"text-name\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-12\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email-patient\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-text wpcf7-validates-as-email form-control\" aria-invalid=\"false\" placeholder=\"Email ID\" value=\"\" type=\"email\" name=\"email-patient\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-12\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"tel-379\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Phone No*\" value=\"\" type=\"tel\" name=\"tel-379\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-12\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"patient-age\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Age*\" value=\"\" type=\"text\" name=\"patient-age\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-12\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"gender\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"gender\"><option value=\"Select Gender*\">Select Gender*<\/option><option value=\"Male\">Male<\/option><option value=\"Female\">Female<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-12\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"services\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" name=\"services\"><option value=\"Select Treatment*\">Select Treatment*<\/option><option value=\"Doctor\u2019s Consultation\">Doctor\u2019s Consultation<\/option><option value=\"Comprehensive Neurocare\">Comprehensive Neurocare<\/option><option value=\"Dental Care\">Dental Care<\/option><option value=\"Urology\">Urology<\/option><option value=\"Vaccination\">Vaccination<\/option><option value=\"Home Care Services\">Home Care Services<\/option><option value=\"Investigations\">Investigations<\/option><option value=\"Pharmacy\">Pharmacy<\/option><option value=\"Investigations\">Investigations<\/option><option value=\"Nephrology\">Nephrology<\/option><\/select><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div class=\"col-12\">\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"AppointmentDate\"><select class=\"wpcf7-form-control wpcf7-select form-control\" aria-invalid=\"false\" name=\"AppointmentDate\"><option value=\"-- Select Day &amp; 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