{"id":4029,"date":"2023-11-16T12:57:53","date_gmt":"2023-11-16T12:57:53","guid":{"rendered":"https:\/\/www.ashleydentalcentre.com\/?page_id=4029"},"modified":"2023-11-16T13:00:24","modified_gmt":"2023-11-16T13:00:24","slug":"referral-form","status":"publish","type":"page","link":"https:\/\/www.ashleydentalcentre.com\/index.php\/referral-form\/","title":{"rendered":"Referral form"},"content":{"rendered":"<h3>Referral form<\/h3>\n<div class=\"forminator-ui forminator-custom-form forminator-custom-form-4031 forminator-design--flat forminator-enclosed forminator_ajax\" data-forminator-render=\"0\" data-form=\"forminator-module-4031\" data-uid=\"69f359bb9998f\"><br\/><\/div><form\n\t\t\t\tid=\"forminator-module-4031\"\n\t\t\t\tclass=\"forminator-ui forminator-custom-form forminator-custom-form-4031 forminator-design--flat forminator-enclosed forminator_ajax\"\n\t\t\t\tmethod=\"post\"\n\t\t\t\tdata-forminator-render=\"0\"\n\t\t\t\tdata-form-id=\"4031\"\n\t\t\t\t data-color-option=\"default\" data-design=\"flat\" data-grid=\"enclosed\" style=\"display: none;\"\n\t\t\t\tdata-uid=\"69f359bb9998f\"\n\t\t\t><div role=\"alert\" aria-live=\"polite\" class=\"forminator-response-message forminator-error\" aria-hidden=\"true\"><\/div><div class=\"forminator-row\"><div id=\"name-1\" class=\"forminator-field-name forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-name-1_69f359bb9998f\" id=\"forminator-field-name-1_69f359bb9998f-label\" class=\"forminator-label\">Patient&#039;s Name <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"name-1\" value=\"\" placeholder=\"\" id=\"forminator-field-name-1_69f359bb9998f\" class=\"forminator-input forminator-name--field\" aria-required=\"true\" autocomplete=\"name\" \/><\/div><\/div><div id=\"email-1\" class=\"forminator-field-email forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-email-1_69f359bb9998f\" id=\"forminator-field-email-1_69f359bb9998f-label\" class=\"forminator-label\">Email Address <span class=\"forminator-required\">*<\/span><\/label><input type=\"email\" name=\"email-1\" value=\"\" placeholder=\"\" id=\"forminator-field-email-1_69f359bb9998f\" class=\"forminator-input forminator-email--field\" data-required=\"true\" aria-required=\"true\" autocomplete=\"email\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"phone-1\" class=\"forminator-field-phone forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-phone-1_69f359bb9998f\" id=\"forminator-field-phone-1_69f359bb9998f-label\" class=\"forminator-label\">Phone Number <span class=\"forminator-required\">*<\/span><\/label><input type=\"text\" name=\"phone-1\" value=\"\" placeholder=\"\" id=\"forminator-field-phone-1_69f359bb9998f\" class=\"forminator-input forminator-field--phone\" data-required=\"1\" aria-required=\"true\" autocomplete=\"off\" \/><\/div><\/div><div id=\"text-1\" class=\"forminator-field-text forminator-col forminator-col-6 \"><div class=\"forminator-field\"><label for=\"forminator-field-text-1_69f359bb9998f\" id=\"forminator-field-text-1_69f359bb9998f-label\" class=\"forminator-label\">Reason for referral<\/label><input type=\"text\" name=\"text-1\" value=\"\" placeholder=\"\" id=\"forminator-field-text-1_69f359bb9998f\" class=\"forminator-input forminator-name--field\" data-required=\"\" \/><\/div><\/div><\/div><div class=\"forminator-row\"><div id=\"captcha-1\" class=\"forminator-field-captcha forminator-col forminator-col-12 \"><div class=\"forminator-captcha-left forminator-hcaptcha\" data-theme=\"light\"  data-sitekey=\"e539a098-793a-4cf6-91b3-269e10c446f1\" data-size=\"normal\"><\/div> <\/div><\/div><input type=\"hidden\" name=\"referer_url\" value=\"\" \/><div class=\"forminator-row forminator-row-last\"><div class=\"forminator-col\"><div class=\"forminator-field\"><button class=\"forminator-button forminator-button-submit\">SUBMIT<\/button><\/div><\/div><\/div><input type=\"hidden\" id=\"forminator_nonce\" name=\"forminator_nonce\" value=\"f2821c31c5\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/4029\" \/><input type=\"hidden\" name=\"form_id\" value=\"4031\"><input type=\"hidden\" name=\"page_id\" value=\"4029\"><input type=\"hidden\" name=\"form_type\" value=\"default\"><input type=\"hidden\" name=\"current_url\" value=\"https:\/\/www.ashleydentalcentre.com\/index.php\/referral-form\/\"><input type=\"hidden\" name=\"render_id\" value=\"0\"><input type=\"hidden\" name=\"action\" value=\"forminator_submit_form_custom-forms\"><\/form>\n","protected":false},"excerpt":{"rendered":"<p>Referral form<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"inline_featured_image":false,"footnotes":""},"class_list":["post-4029","page","type-page","status-publish","hentry"],"blocksy_meta":{"styles_descriptor":{"styles":{"desktop":"","tablet":"","mobile":""},"google_fonts":[],"version":6}},"_links":{"self":[{"href":"https:\/\/www.ashleydentalcentre.com\/index.php\/wp-json\/wp\/v2\/pages\/4029","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ashleydentalcentre.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.ashleydentalcentre.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.ashleydentalcentre.com\/index.php\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ashleydentalcentre.com\/index.php\/wp-json\/wp\/v2\/comments?post=4029"}],"version-history":[{"count":10,"href":"https:\/\/www.ashleydentalcentre.com\/index.php\/wp-json\/wp\/v2\/pages\/4029\/revisions"}],"predecessor-version":[{"id":4040,"href":"https:\/\/www.ashleydentalcentre.com\/index.php\/wp-json\/wp\/v2\/pages\/4029\/revisions\/4040"}],"wp:attachment":[{"href":"https:\/\/www.ashleydentalcentre.com\/index.php\/wp-json\/wp\/v2\/media?parent=4029"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}