{"id":7119,"date":"2019-01-24T15:34:38","date_gmt":"2019-01-24T08:34:38","guid":{"rendered":"https:\/\/peacedentistry.com\/?page_id=7119"},"modified":"2021-01-22T13:20:41","modified_gmt":"2021-01-22T06:20:41","slug":"booking-an-appointment","status":"publish","type":"page","link":"https:\/\/peacedentistry.com\/en\/booking-an-appointment\/","title":{"rendered":"Booking an Appointment"},"content":{"rendered":"\n\t\t<div class=\"row w3-padding-32\">\r\n\t\t<div class=\"col-xs-12 col-sm-8 col-md-7 col-sm-offset-2 col-md-offset-3\">\r\n\t\t\t<h2 id=\"publicform\">Booking an Appointment<\/h2>\r\n\t\t\t<form action=\"\" method=\"POST\">\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"form-group col-xs-12 col-sm-6\">\r\n\t\t\t\t\t\t<label for=\"exampleInputName\">Name (*)<\/label>\r\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"exampleInputName\" name=\"txtName\" placeholder=\"Name input\">\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"formm-group col-xs-12 col-sm-6\">\r\n\t\t\t\t\t\t<label for=\"exampleInputEmail\">Email address (*)<\/label>\r\n\t\t\t\t\t\t<input type=\"email\" class=\"form-control\" id=\"exampleInputEmail\" name=\"txtEmail\" placeholder=\"Email input\">\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"row\">\r\n\t\t\t\t\t<div class=\"form-group col-xs-12 col-sm-6\">\r\n\t\t\t\t\t\t<label for=\"exampleInputPhone\">Phone (*)<\/label>\r\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"exampleInputphone\" name=\"txtPhone\" placeholder=\"Phone input\">\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"form-group col-xs-12 col-sm-2\">\r\n\t\t\t\t\t\t<label for=\"exampleInputAge\">Age<\/label>\r\n\t\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"exampleInputAge\" name=\"txtAge\" placeholder=\"Age input\">\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<div class=\"form-group col-xs-12 col-sm-4\">\r\n\t\t\t\t\t\t<label>Gender<\/label>\r\n\t\t\t\t\t\t<div class=\"radio\">\r\n\t\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t<input type=\"radio\" name=\"optionsRadios\" id=\"optionsRadios1\" name=\"txtFemale\" value=\"Female\"> Female \r\n\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t<input type=\"radio\" name=\"optionsRadios\" id=\"optionsRadios2\" name=\"txtMale\" value=\"Male\"> Male \r\n\t\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<div class=\"form-group\">\r\n\t\t\t\t\t<label for=\"exampleInputFile\">Require<\/label>\r\n\t\t\t\t\t<textarea class=\"form-control\" rows=\"3\" name=\"txtReq\" placeholder=\"Please describe your teeth condition and treatment requirement so our doctor can give you exact consultant\"><\/textarea>\r\n\t\t\t\t<\/div>\r\n\t\t\t\t<!--<div class=\"form-group\">\r\n\t\t\t\t\t<label for=\"exampleInputCaptcha\">Captcha<\/label>\r\n\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"\/en\/captcha.php?n=\" onclick=\"changeCaptcha(this)\" width=\"120\" height=\"45\"\/>\r\n\t\t\t\t\t<input type=\"text\" class=\"form-control\" id=\"exampleInputCaptcha\" name=\"captcha\">\r\n\t\t\t\t<\/div>-->\r\n\t\t\t\t<button type=\"submit\" name=\"submit\" class=\"btn btn-info\">Submit<\/button>\r\n\t\t\t<\/form>\r\n\t\t\t\t\t\t<script type=\"text\/javascript\">\r\n\t\t\t\t\/*function changeCaptcha(obj){\r\n\t\t\t\t    var n = Math.random();\r\n\t\t\t\t    obj.setAttribute('src','\/en\/captcha.php?n='+n);\r\n\t\t\t\t}*\/\r\n\t\t\t<\/script>\r\n\t\t<\/div>\r\n\t<\/div>\r\n\t\t\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/form-template.php","meta":{"footnotes":""},"class_list":["post-7119","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/peacedentistry.com\/en\/wp-json\/wp\/v2\/pages\/7119","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/peacedentistry.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/peacedentistry.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/peacedentistry.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/peacedentistry.com\/en\/wp-json\/wp\/v2\/comments?post=7119"}],"version-history":[{"count":2,"href":"https:\/\/peacedentistry.com\/en\/wp-json\/wp\/v2\/pages\/7119\/revisions"}],"predecessor-version":[{"id":7333,"href":"https:\/\/peacedentistry.com\/en\/wp-json\/wp\/v2\/pages\/7119\/revisions\/7333"}],"wp:attachment":[{"href":"https:\/\/peacedentistry.com\/en\/wp-json\/wp\/v2\/media?parent=7119"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}