{"id":146,"date":"2024-10-26T08:48:49","date_gmt":"2024-10-26T08:48:49","guid":{"rendered":"https:\/\/drmais-clinic.com\/?page_id=146"},"modified":"2024-11-14T23:16:19","modified_gmt":"2024-11-14T23:16:19","slug":"form3","status":"publish","type":"page","link":"https:\/\/drmais-clinic.com\/index.php\/form3\/","title":{"rendered":"form3"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"146\" class=\"elementor elementor-146\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8463465 e-flex e-con-boxed e-con e-parent\" data-id=\"8463465\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d7e12ba elementor-widget elementor-widget-shortcode\" data-id=\"d7e12ba\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><script>document.addEventListener('wpcf7mailsent', function(event) {\r\n    \/\/ Check if the modal already exists to avoid duplication\r\n    if (!document.getElementById('form-success-modal')) {\r\n        \/\/ Add the modal HTML to the page\r\n        document.body.insertAdjacentHTML('beforeend', `\r\n            <div id=\"form-success-modal\" style=\"display: flex; position: fixed; top: 0; left: 0; width: 100%; height: 100%; background-color: rgba(0,0,0,0.5); justify-content: center; align-items: center; z-index: 9999;\">\r\n                <div style=\"background-color: white; padding: 20px; border-radius: 5px; max-width: 400px; text-align: center;\">\r\n                    <p>Your form has been submitted successfully.<\/p>\r\n                    <button id=\"modal-ok-button\" style=\"margin-top: 15px; padding: 10px 20px; background-color: #4CAF50; color: #fff; border: none; border-radius: 3px; cursor: pointer;\">OK<\/button>\r\n                <\/div>\r\n            <\/div>\r\n        `);\r\n    }\r\n\r\n    \/\/ Show the modal\r\n    document.getElementById('form-success-modal').style.display = 'flex';\r\n\r\n    \/\/ Add event listener for the \"OK\" button to hide the modal and refresh the page\r\n    document.getElementById('modal-ok-button').addEventListener('click', function() {\r\n        document.getElementById('form-success-modal').style.display = 'none';\r\n        location.reload(); \/\/ Refresh the page\r\n    });\r\n}, false);\r\n<\/script><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-c3e525d e-flex e-con-boxed e-con e-parent\" data-id=\"c3e525d\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-09605b6 elementor-widget elementor-widget-shortcode\" data-id=\"09605b6\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f138-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=\"\/index.php\/wp-json\/wp\/v2\/pages\/146#wpcf7-f138-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"138\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.9.8\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f138-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<input type=\"hidden\" name=\"redirect_nonce\" value=\"a78acd0dd0\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_name\" value=\"Form3-\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_reference\" value=\"4628b7a3\" \/>\n<input type=\"hidden\" name=\"wpcf7cfpdf_hidden_date\" value=\"May29,2026\" \/>\n<\/div>\n<style> \ninput.wpcf7-form-control.wpcf7-text.textinfo {\n width: 100% !important;\n}\n<\/style>\n<div class=\"textinfo\" style=\"\n    display: flex;\n    direction: rtl;\n    flex-direction: column;\n    background-color: beige;\n    padding: 10px;\n border-radius: 10px; margin: 10px;\n\">\n\t<p style=\"direction: rtl; margin: 5px 0;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-781\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required textinfo\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u05e9\u05dd \u05de\u05dc\u05d0\" value=\"\" type=\"text\" name=\"text-781\" \/><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl; margin: 5px 0;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-782\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required textinfo\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u05ea&quot;\u05d6\" value=\"\" type=\"text\" name=\"text-782\" \/><\/span>\n\t<\/p>\n<\/div>\n<div class=\"textinfo\" style=\"\n    display: flex;\n    direction: rtl;\n    flex-direction: column;\n    background-color: beige;\n    padding: 10px;\n border-radius: 10px; margin: 10px;\n\">\n\t<p style=\"direction: rtl; margin: 5px 0;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-783\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required textinfo\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u05d8\u05dc\u05e4\u05d5\u05df\" value=\"\" type=\"text\" name=\"text-783\" \/><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl; margin: 5px 0;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-784\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required textinfo\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u05e0\u05d9\u05d9\u05d3\" value=\"\" type=\"text\" name=\"text-784\" \/><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl; margin: 5px 0;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-785\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required textinfo\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u05ea\u05d0\u05e8\u05d9\u05da \u05dc\u05d9\u05d3\u05d4\" value=\"\" type=\"text\" name=\"text-785\" \/><\/span>\n\t<\/p>\n<\/div>\n<hr \/>\n<div class=\"textinfo\" style=\"\n    display: flex;\n    direction: rtl;\n    flex-direction: column;\n    background-color: beige;\n    padding: 15px;\n border-radius: 10px; margin: 10px;\n\">\n\t<p style=\"direction: rtl;\">\u05d4\u05d0\u05dd \u05e2\u05d1\u05e8\u05ea \u05d1\u05e2\u05d1\u05e8 \u05d8\u05d9\u05e4\u05d5\u05dc \u05e9\u05dc \u05d4\u05d6\u05e8\u05e7\u05d5\u05ea \u05d0\u05e1\u05ea\u05d8\u05d9\u05e7\u05d4? <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-260\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-260[]\" value=\"\u05dc\u05d0\" \/><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-260[]\" value=\"\u05db\u05df\" \/><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-7811\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text textinfo\" aria-invalid=\"false\" placeholder=\"\u05e4\u05e8\u05d8\" value=\"\" type=\"text\" name=\"text-7811\" \/><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"> \u05d4\u05d0\u05dd \u05d0\u05ea \u05d1\u05d4\u05e8\u05d9\u05d5\u05df? <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-261\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-261[]\" value=\"\u05dc\u05d0\" \/><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-261[]\" value=\"\u05db\u05df\" \/><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-7871\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text textinfo\" aria-invalid=\"false\" placeholder=\"\u05de\u05e2\u05df\" value=\"\" type=\"text\" name=\"text-7871\" \/><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"> \u05d4\u05d0\u05dd \u05d0\u05ea \u05de\u05e0\u05d9\u05e7\u05d4? <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-262\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-262[]\" value=\"\u05dc\u05d0\" \/><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-262[]\" value=\"\u05db\u05df\" \/><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-7881\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text textinfo\" aria-invalid=\"false\" placeholder=\"\u05d8\u05dc\u05e4\u05d5\u05df\" value=\"\" type=\"text\" name=\"text-7881\" \/><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"> \u05d4\u05d0\u05dd \u05d0\u05ea\\\u05d4 \u05e0\u05d5\u05d8\u05dc\\\u05ea \u05ea\u05e8\u05d5\u05e4\u05d5\u05ea \u05d1\u05d0\u05d5\u05e4\u05df \u05e7\u05d1\u05d5\u05e2? <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-263\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-263[]\" value=\"\u05dc\u05d0\" \/><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-263[]\" value=\"\u05db\u05df\" \/><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-7891\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text textinfo\" aria-invalid=\"false\" placeholder=\"\u05d8\u05dc\u05e4\u05d5\u05df\" value=\"\" type=\"text\" name=\"text-7891\" \/><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"> \u05d4\u05d0\u05dd \u05d0\u05ea\\\u05d4 \u05d7\u05d5\u05dc\u05d4 \u05d1\u05de\u05d7\u05dc\u05d4\\\u05d5\u05ea \u05db\u05e8\u05d5\u05e0\u05d9\u05d5\u05ea? <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-264\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-264[]\" value=\"\u05dc\u05d0\" \/><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-264[]\" value=\"\u05db\u05df\" \/><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-7882\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text textinfo\" aria-invalid=\"false\" placeholder=\"\u05d8\u05dc\u05e4\u05d5\u05df\" value=\"\" type=\"text\" name=\"text-7882\" \/><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"> \u05d4\u05d0\u05dd \u05d0\u05ea\\\u05d4 \u05e1\u05d5\u05d1\u05dc\\\u05ea \u05de\u05d0\u05dc\u05e8\u05d2\u05d9\u05d5\u05ea? <span class=\"wpcf7-form-control-wrap\" data-name=\"checkbox-265\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"checkbox-265[]\" value=\"\u05dc\u05d0\" \/><span class=\"wpcf7-list-item-label\">\u05dc\u05d0<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"checkbox-265[]\" value=\"\u05db\u05df\" \/><span class=\"wpcf7-list-item-label\">\u05db\u05df<\/span><\/label><\/span><\/span><\/span>\n\t<\/p>\n\t<p style=\"direction: rtl;\"><span class=\"wpcf7-form-control-wrap\" data-name=\"text-7883\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text textinfo\" aria-invalid=\"false\" placeholder=\"\u05d8\u05dc\u05e4\u05d5\u05df\" value=\"\" type=\"text\" name=\"text-7883\" \/><\/span>\n\t<\/p>\n<\/div>\n<hr \/>\n<div class=\"textinfo\" style=\"\n    padding: 15px;\n border-radius: 10px; margin: 10px;\n\">\n\t<p style=\"direction: rtl;\">\u05d4\u05e1\u05db\u05de\u05ea \u05d4\u05de\u05d8\u05d5\u05e4\\\u05ea:\n\t<\/p>\n\t<p style=\"direction: rtl;\">\u05d1\u05d7\u05ea\u05d9\u05de\u05ea\u05d9 \u05d4\u05d4\u05e0\u05d9 \u05de\u05e6\u05d4\u05d9\u05e8\\\u05d4 \u05db\u05d9 \u05d4\u05e4\u05e8\u05d8\u05d9\u05dd \u05d0\u05e9\u05e8 \u05de\u05d5\u05dc\u05d0\u05d5 \u05d1\u05d2\u05d9\u05dc\u05d9\u05d5\u05df \u05d6\u05d4 \u05de\u05d5\u05dc\u05d0\u05d5 \u05e2\u05dc \u05d9\u05d3\u05d9 \u05d5\u05d4\u05d9\u05e0\u05dd \u05e0\u05db\u05d5\u05e0\u05d9\u05dd.\n\t<\/p>\n<\/div>\n<p style=\"direction: rtl; margin: 10px 0;\">\u05d7\u05ea\u05d9\u05de\u05ea \u05d4\u05de\u05d8\u05d5\u05e4\u05dc <div class=\"wpcf7-form-control-wrap signature-837\"  data-name=\"signature-837\"><div class='cf7_signature-container cf7_signature-container-signature-837'><div class='cf7_signature_clear'><img src='https:\/\/drmais-clinic.com\/wp-content\/plugins\/contact-form-7-signature\/frontend\/lib\/images\/remove-icon.png' alt='' \/><\/div><div class='cf7_signature cf7_signature-signature-837'  data-id=\"signature-837\" data-background=\"#fff\" data-color=\"#000000\" data-width=\"300\" data-height=\"200\" data-name=\"\"><\/div><\/div><style>\r\n            .cf7_signature-container-signature-837 .cf7_signature_name,.cf7_signature-container-signature-837 {\r\n                width: 300px;\r\n            }\r\n            .cf7_signature-container-signature-837 .kbw-signature,.cf7_signature-container-signature-837 .gf_signature  { width: 300px; height: 200px; }\r\n        <\/style><input class=\"wpcf7-form-control wpcf7-signature wpcf7-validates-as-required wpcf7-text signatur\" aria-required=\"true\" aria-invalid=\"false\" type=\"hidden\" name=\"signature-837\" \/><\/div>\n<\/p>\n<div class=\"textinfo\" style=\"\n    display: flex;\n    direction: rtl;\n    flex-direction: column;\n    padding: 15px;\n border-radius: 10px; margin: 10px;\n\">\n\t<p><img decoding=\"async\" src=\"https:\/\/drmais-clinic.com\/wp-content\/uploads\/2024\/11\/Mask-group-1-1.png\" alt=\"\" style=\"width: 100%; max-width: 238px; height: auto; margin-top: 10px;\" \/>\n\t<\/p>\n<\/div>\n<p style=\"direction: rtl; text-align: center;\"><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"\u062a\u0642\u062f\u064a\u0645 \u0627\u0644\u0637\u0644\u0628\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-146","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/drmais-clinic.com\/index.php\/wp-json\/wp\/v2\/pages\/146","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/drmais-clinic.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/drmais-clinic.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/drmais-clinic.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/drmais-clinic.com\/index.php\/wp-json\/wp\/v2\/comments?post=146"}],"version-history":[{"count":5,"href":"https:\/\/drmais-clinic.com\/index.php\/wp-json\/wp\/v2\/pages\/146\/revisions"}],"predecessor-version":[{"id":534,"href":"https:\/\/drmais-clinic.com\/index.php\/wp-json\/wp\/v2\/pages\/146\/revisions\/534"}],"wp:attachment":[{"href":"https:\/\/drmais-clinic.com\/index.php\/wp-json\/wp\/v2\/media?parent=146"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}