{"id":938,"date":"2025-11-14T11:44:06","date_gmt":"2025-11-14T11:44:06","guid":{"rendered":"https:\/\/siteovia.com\/core\/?page_id=938"},"modified":"2025-11-14T12:27:10","modified_gmt":"2025-11-14T12:27:10","slug":"new-patient-registration-form","status":"publish","type":"page","link":"https:\/\/siteovia.com\/core\/new-patient-registration-form\/","title":{"rendered":"New Patient Registration Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"938\" class=\"elementor elementor-938\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3a1a044 e-flex e-con-boxed e-con e-parent\" data-id=\"3a1a044\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-b0e7fa2 e-con-full e-flex e-con e-child\" data-id=\"b0e7fa2\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t<div class=\"elementor-element elementor-element-fdf9a5e e-con-full e-flex e-con e-child\" data-id=\"fdf9a5e\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-64f895d elementor-widget elementor-widget-heading\" data-id=\"64f895d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">New Patient Registration Form<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1b11e76 elementor-widget elementor-widget-text-editor\" data-id=\"1b11e76\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t\t\t\t\t\t<p>Click Submit, and we will reach out to you soon.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-b66cbef e-con-full e-flex e-con e-child\" data-id=\"b66cbef\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4467345 elementor-widget elementor-widget-metform\" data-id=\"4467345\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"metform.default\">\n\t\t\t\t\t<div id=\"mf-response-props-id-943\" data-previous-steps-style=\"\" data-editswitchopen=\"\" data-response_type=\"alert\" data-erroricon=\"fas fa-exclamation-triangle\" data-successicon=\"fas fa-check\" data-messageposition=\"top\" class=\"   mf-scroll-top-no\">\n\t\t<div class=\"formpicker_warper formpicker_warper_editable\" data-metform-formpicker-key=\"943\" >\n\t\t\t\t\n\t\t\t<div class=\"mf-widget-container\">\n\t\t\t\t\r\n\t\t<div\r\n\t\t\tid=\"metform-wrap-4467345-943\"\r\n\t\t\tclass=\"mf-form-wrapper\"\r\n\t\t\tdata-form-id=\"943\"\r\n\t\t\tdata-action=\"https:\/\/siteovia.com\/core\/wp-json\/metform\/v1\/entries\/insert\/943\"\r\n\t\t\tdata-wp-nonce=\"1870994ff8\"\r\n\t\t\tdata-form-nonce=\"61b147a08f\"\r\n\t\t\tdata-quiz-summery = \"false\"\r\n\t\t\tdata-save-progress = \"false\"\r\n\t\t\tdata-form-type=\"general-form\"\r\n\t\t\tdata-stop-vertical-effect=\"\"\r\n\t\t\tdata-payment-submit-before=\"0\"\r\n\t\t\t><\/div>\r\n\r\n\r\n\t\t<!----------------------------- \r\n\t\t\t* controls_data : find the the props passed indie of data attribute\r\n\t\t\t* props.SubmitResponseMarkup : contains the markup of error or success message\r\n\t\t\t* https:\/\/developer.mozilla.org\/en-US\/docs\/Web\/JavaScript\/Reference\/Template_literals\r\n\t\t--------------------------- -->\r\n\r\n\t\t\t\t<script type=\"text\/mf\" class=\"mf-template\">\r\n\t\t\tfunction controls_data (value){\r\n\t\t\t\tlet currentWrapper = \"mf-response-props-id-943\";\r\n\t\t\t\tlet currentEl = document.getElementById(currentWrapper);\r\n\t\t\t\t\r\n\t\t\t\treturn currentEl ? currentEl.dataset[value] : false\r\n\t\t\t}\r\n\r\n\r\n\t\t\tlet is_edit_mode = '' ? true : false;\r\n\t\t\tlet message_position = controls_data('messageposition') || 'top';\r\n\r\n\t\t\t\r\n\t\t\tlet message_successIcon = controls_data('successicon') || '';\r\n\t\t\tlet message_errorIcon = controls_data('erroricon') || '';\r\n\t\t\tlet message_editSwitch = controls_data('editswitchopen') === 'yes' ? true : false;\r\n\t\t\tlet message_proClass = controls_data('editswitchopen') === 'yes' ? 'mf_pro_activated' : '';\r\n\t\t\t\r\n\t\t\tlet is_dummy_markup = is_edit_mode && message_editSwitch ? true : false;\r\n\r\n\t\t\t\r\n\t\t\treturn html`\r\n\t\t\t\t<form\r\n\t\t\t\t\tclassName=\"metform-form-content\"\r\n\t\t\t\t\tref=${parent.formContainerRef}\r\n\t\t\t\t\tonSubmit=${ validation.handleSubmit( parent.handleFormSubmit ) }\r\n\t\t\t\t\r\n\t\t\t\t\t>\r\n\t\t\t\r\n\t\t\t\r\n\t\t\t\t\t${is_dummy_markup ? message_position === 'top' ?  props.ResponseDummyMarkup(message_successIcon, message_proClass) : '' : ''}\r\n\t\t\t\t\t${is_dummy_markup ? ' ' :  message_position === 'top' ? props.SubmitResponseMarkup`${parent}${state}${message_successIcon}${message_errorIcon}${message_proClass}` : ''}\r\n\r\n\t\t\t\t\t<!--------------------------------------------------------\r\n\t\t\t\t\t*** IMPORTANT \/ DANGEROUS ***\r\n\t\t\t\t\t${html``} must be used as in immediate child of \"metform-form-main-wrapper\"\r\n\t\t\t\t\tclass otherwise multistep form will not run at all\r\n\t\t\t\t\t---------------------------------------------------------->\r\n\r\n\t\t\t\t\t<div className=\"metform-form-main-wrapper\" key=${'hide-form-after-submit'} ref=${parent.formRef}>\r\n\t\t\t\t\t${html`\r\n\t\t\t\t\t\t\t\t<div data-elementor-type=\"wp-post\" key=\"2\" data-elementor-id=\"943\" className=\"elementor elementor-943\" data-elementor-post-type=\"metform-form\">\n\t\t\t\t<div className=\"elementor-element elementor-element-df1f1d4 e-con-full e-flex e-con e-parent\" data-id=\"df1f1d4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div className=\"elementor-element elementor-element-1f9e9e4 e-con-full e-flex e-con e-child\" data-id=\"1f9e9e4\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div className=\"elementor-element elementor-element-f6c8784 e-con-full e-flex e-con e-child\" data-id=\"f6c8784\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t<div className=\"elementor-element elementor-element-8b87181 e-con-full e-flex e-con e-child\" data-id=\"8b87181\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div className=\"elementor-element elementor-element-1fa7a6c elementor-widget elementor-widget-heading\" data-id=\"1fa7a6c\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 className=\"elementor-heading-title elementor-size-default\">Services for:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-950d820 elementor-widget elementor-widget-mf-radio\" data-id=\"950d820\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-radio&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;Yourself&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;f83ebc4&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Someone else&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;3c1cbc3&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-radio.default\">\n\t\t\t\t\t\t\r\n\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\r\n\t\t\t<div className=\"mf-radio multi-option-input-type\" id=\"mf-input-radio-950d820\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-1\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-1' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`Yourself`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-2\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-2' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`Someone else`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"mf-radio\" value=\"\" \/>\r\n\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-e19b32d elementor-widget elementor-widget-heading\" data-id=\"e19b32d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 className=\"elementor-heading-title elementor-size-default\">Services for:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-3df5e09 elementor-widget elementor-widget-mf-listing-fname\" data-id=\"3df5e09\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-listing-fname&quot;}\" data-widget_type=\"mf-listing-fname.default\">\n\t\t\t\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\n\t\t\t<input type=\"text\" className=\"mf-input \" id=\"mf-input-text-3df5e09\" \n\t\t\t\tname=\"mf-listing-fname\" \n\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Name`) } \"\n\t\t\t\tonInput=${ parent.handleChange }\n\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-listing-fname'] ? 'true' : 'false'}\n\t\t\t\t\tref=${ el => parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el) }\n\t\t\t\t\t\t\t\/>\n\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-listing-fname\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-d1c4661 elementor-widget elementor-widget-mf-email\" data-id=\"d1c4661\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-email&quot;}\" data-widget_type=\"mf-email.default\">\n\t\t\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\r\n\t\t\t<input \r\n\t\t\t\ttype=\"email\" \r\n\t\t\t\t \r\n\t\t\t\tdefaultValue=\"\" \r\n\t\t\t\tclassName=\"mf-input \" \r\n\t\t\t\tid=\"mf-input-email-d1c4661\" \r\n\t\t\t\tname=\"mf-email\" \r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Email`) } \" \r\n\t\t\t\t \r\n\t\t\t\tonBlur=${parent.handleChange} onFocus=${parent.handleChange} aria-invalid=${validation.errors['mf-email'] ? 'true' : 'false' } \r\n\t\t\t\tref=${el=> parent.activateValidation({\"message\":\"This field is required.\",\"emailMessage\":\"Please enter a valid Email address\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t<${validation.ErrorMessage} \r\n\t\t\t\terrors=${validation.errors} \r\n\t\t\t\tname=\"mf-email\" \r\n\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-554b257 elementor-widget elementor-widget-mf-telephone\" data-id=\"554b257\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-telephone&quot;}\" data-widget_type=\"mf-telephone.default\">\n\t\t\t\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\n\t\t\t<input\n\t\t\t\ttype=\"tel\"\n\t\t\t\tclassName=\"mf-input \"\n\t\t\t\tid=\"mf-input-telephone-554b257\" \n\t\t\t\tname=\"mf-telephone\"\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Phone Number`) } \"\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\n\t\t\t\t\taria-invalid=${validation.errors['mf-telephone'] ? 'true' : 'false'}\n\t\t\t\t\tref=${el => parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":false,\"expression\":\"null\"}, el)}\n\t\t\t\t\t\t\t\t\/>\n\t\t\t\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-telephone\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\n\t\t\t\n\t\t<\/div>\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-f84ea4f elementor-widget elementor-widget-mf-date\" data-id=\"f84ea4f\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-date&quot;}\" data-widget_type=\"mf-date.default\">\n\t\t\t\t\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\r\n\t\t\t<${props.Flatpickr}\r\n\t\t\t\t\tname=\"mf-date\"\r\n\t\t\t\t\tclassName=\"mf-input mf-date-input mf-left-parent  \"\r\n\t\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Date Of Birth (mm\/dd\/yyyy)`) } \"\r\n\t\t\t\t\toptions=${{\"minDate\":\"\",\"maxDate\":\"\",\"dateFormat\":\"m-d-Y\",\"enableTime\":\"\",\"disable\":[],\"mode\":\"single\",\"static\":true,\"disableMobile\":true,\"time_24hr\":false}}\r\n\t\t\t\t\tvalue=${parent.getValue('mf-date')}\r\n\t\t\t\t\tonInput=${parent.handleDateTime}\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-date'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${el => props.DateWidget(\r\n\t\t\t\t\t\t\tel, \r\n\t\t\t\t\t\t\t'', \r\n\t\t\t\t\t\t\t{\"message\":\"This field is required.\",\"required\":false},  \r\n\t\t\t\t\t\t\tregister, \r\n\t\t\t\t\t\t\tparent \r\n\t\t\t\t\t\t)}\r\n\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-date\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-820fbe5 elementor-widget elementor-widget-mf-text\" data-id=\"820fbe5\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\r\n\t\t\t<input\r\n\t\t\t\ttype=\"text\"\r\n\t\t\t\tclassName=\"mf-input \"\r\n\t\t\t\tid=\"mf-input-text-820fbe5\"\r\n\t\t\t\tname=\"mf-text\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Psychotropic medications currently taken (if any):`) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${parent.handleChange}\r\n\t\t\t\t\tonBlur=${parent.handleChange}\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-text'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":false,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-text\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-e922b52 elementor-widget elementor-widget-heading\" data-id=\"e922b52\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 className=\"elementor-heading-title elementor-size-default\">Appointment\/Scheduling Information:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-27a8269 elementor-widget elementor-widget-mf-radio\" data-id=\"27a8269\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-radio&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;San Francisco&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;f83ebc4&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;East Bay&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;3c1cbc3&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;North Bay&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;5c53ddf&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Other&quot;,&quot;mf_input_option_value&quot;:&quot;value-4&quot;,&quot;_id&quot;:&quot;d0de9cb&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-radio.default\">\n\t\t\t\t\t\t\r\n\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-radio-27a8269\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Location Preference`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\"><\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div className=\"mf-radio multi-option-input-type\" id=\"mf-input-radio-27a8269\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-1\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-1' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`San Francisco`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-2\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-2' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`East Bay`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-3\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-3' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`North Bay`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-4\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-4' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`Other`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"mf-radio\" value=\"\" \/>\r\n\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-d33f063 elementor-widget elementor-widget-mf-select\" data-id=\"d33f063\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;Weekly counseling with a therapist&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;ef75803&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Medication Management with a Psychiatrist&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;777bbad&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Both&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;fb0a1ec&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Unsure&quot;,&quot;mf_input_option_value&quot;:&quot;value-4&quot;,&quot;_id&quot;:&quot;11f6473&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\n            <${props.Select}\n                className=${\"mf-input mf-input-select  \" + ( validation.errors['mf-select'] ? 'mf-invalid' : '' )}\n                classNamePrefix=\"mf_select\"\n                name=\"mf-select\"\n                placeholder=\"${ parent.decodeEntities(`I am looking for:`) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Weekly counseling with a therapist\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Medication Management with a Psychiatrist\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Both\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Unsure\",\"value\":\"value-4\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select\") ? [{\"label\":\"Weekly counseling with a therapist\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Medication Management with a Psychiatrist\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Both\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Unsure\",\"value\":\"value-4\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":false}));\n                    if ( parent.getValue(\"mf-select\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-select\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-2121060 e-con-full e-flex e-con e-child\" data-id=\"2121060\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div className=\"elementor-element elementor-element-dc479f8 elementor-widget elementor-widget-spacer\" data-id=\"dc479f8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t\t\t\t<div className=\"elementor-spacer\">\n\t\t\t<div className=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-78e6730 elementor-widget elementor-widget-heading\" data-id=\"78e6730\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 className=\"elementor-heading-title elementor-size-default\">Insurance Information: *<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-6d60519 elementor-widget elementor-widget-mf-select\" data-id=\"6d60519\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;Aetna&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;ef75803&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Alameda Alliance&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;777bbad&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Anthem&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;fb0a1ec&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Blue Shield&quot;,&quot;mf_input_option_value&quot;:&quot;value-4&quot;,&quot;_id&quot;:&quot;11f6473&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\n            <${props.Select}\n                className=${\"mf-input mf-input-select  \" + ( validation.errors['mf-select'] ? 'mf-invalid' : '' )}\n                classNamePrefix=\"mf_select\"\n                name=\"mf-select\"\n                placeholder=\"${ parent.decodeEntities(`Insurance Provider`) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Aetna\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Alameda Alliance\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Anthem\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Blue Shield\",\"value\":\"value-4\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select\") ? [{\"label\":\"Aetna\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Alameda Alliance\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Anthem\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Blue Shield\",\"value\":\"value-4\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":false}));\n                    if ( parent.getValue(\"mf-select\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-select\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-9f95c91 elementor-widget elementor-widget-mf-radio\" data-id=\"9f95c91\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-radio&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;Yes&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;f83ebc4&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;No&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;3c1cbc3&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Unsure&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;5c53ddf&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-radio.default\">\n\t\t\t\t\t\t\r\n\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-radio-9f95c91\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Do you have a Medicare, MediCal, or EAP insurance plan?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\"><\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div className=\"mf-radio multi-option-input-type\" id=\"mf-input-radio-9f95c91\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-1\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-1' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`Yes`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-2\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-2' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`No`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-3\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-3' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`Unsure`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"mf-radio\" value=\"\" \/>\r\n\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-d89a205 elementor-widget elementor-widget-heading\" data-id=\"d89a205\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 className=\"elementor-heading-title elementor-size-default\">If unsure, please reach out to your insurance directly to find this information out, so we can better assist you.\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-70ea526 elementor-widget elementor-widget-mf-select\" data-id=\"70ea526\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;Referral from family or a friend&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;ef75803&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Insurance company&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;777bbad&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Internet search&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;fb0a1ec&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Primary care or other provider&quot;,&quot;mf_input_option_value&quot;:&quot;value-4&quot;,&quot;_id&quot;:&quot;11f6473&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\n            <${props.Select}\n                className=${\"mf-input mf-input-select  \" + ( validation.errors['mf-select'] ? 'mf-invalid' : '' )}\n                classNamePrefix=\"mf_select\"\n                name=\"mf-select\"\n                placeholder=\"${ parent.decodeEntities(`How did you hear about us?`) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Referral from family or a friend\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Insurance company\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Internet search\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Primary care or other provider\",\"value\":\"value-4\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select\") ? [{\"label\":\"Referral from family or a friend\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Insurance company\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Internet search\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Primary care or other provider\",\"value\":\"value-4\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":false}));\n                    if ( parent.getValue(\"mf-select\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${validation.ErrorMessage}\n\t\t\t\t\terrors=${validation.errors}\n\t\t\t\t\tname=\"mf-select\"\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-eef8728 elementor-widget elementor-widget-mf-radio\" data-id=\"eef8728\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-radio&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;In-person&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;f83ebc4&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Virtual&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;3c1cbc3&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-radio.default\">\n\t\t\t\t\t\t\r\n\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-radio-eef8728\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Are you looking for in-person or virtual appointments?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\"><\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div className=\"mf-radio multi-option-input-type\" id=\"mf-input-radio-eef8728\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-1\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-1' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`In-person`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-2\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-2' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`Virtual`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"mf-radio\" value=\"\" \/>\r\n\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-52c9599 elementor-widget elementor-widget-mf-radio\" data-id=\"52c9599\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-radio&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;Email&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;f83ebc4&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Phone&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;3c1cbc3&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-radio.default\">\n\t\t\t\t\t\t\r\n\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-radio-52c9599\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Preferred Method of Communication:`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\"><\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div className=\"mf-radio multi-option-input-type\" id=\"mf-input-radio-52c9599\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-1\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-1' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`Email`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t\t\t<div className=\"mf-radio-option \">\r\n\t\t\t\t\t\t<label>\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input\r\n\t\t\t\t\t\t\t\ttype=\"radio\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-radio-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\t\t\t\tvalue=\"value-2\"\r\n\t\t\t\t\t\t\t\tdata-checked=\"\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tonChange=${ parent.handleChange }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-radio'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.handleRadioDefault(el);\r\n\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"required\":false}, el)\r\n\t\t\t\t\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\tchecked=${'value-2' === parent.getValue('mf-radio')}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`Phone`) } \t\t\t\t\t\t\t<\/span>\r\n\t\t\t\t\t\t<\/label>\r\n\t\t\t\t\t<\/div>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-radio\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t\t<input type=\"hidden\" name=\"mf-radio\" value=\"\" \/>\r\n\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-2c92df5 e-con-full e-flex e-con e-child\" data-id=\"2c92df5\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div className=\"elementor-element elementor-element-1b5367d elementor-widget elementor-widget-heading\" data-id=\"1b5367d\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 className=\"elementor-heading-title elementor-size-default\">What else would you like us to know?<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-3c6513e elementor-widget elementor-widget-mf-textarea\" data-id=\"3c6513e\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-textarea&quot;}\" data-widget_type=\"mf-textarea.default\">\n\t\t\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\r\n\t\t\t<textarea className=\"mf-input mf-textarea \" id=\"mf-input-text-area-3c6513e\"\r\n\t\t\t\tname=\"mf-textarea\" \r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(`Your Message`) } \"\r\n\t\t\t\tcols=\"30\" rows=\"10\"\r\n\t\t\t\t\t\t\t\t\tonInput=${ parent.handleChange }\r\n\t\t\t\t\taria-invalid=${validation.errors['mf-textarea'] ? 'true' : 'false'}\r\n\t\t\t\t\tref=${ el => parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":false,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\t><\/textarea>\r\n\r\n\t\t\t\t\t\t\t<${validation.ErrorMessage}\r\n\t\t\t\t\terrors=${validation.errors}\r\n\t\t\t\t\tname=\"mf-textarea\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-d1da3ad mf-btn--justify mf-btn--tablet-justify mf-btn--mobile-justify elementor-widget elementor-widget-mf-button\" data-id=\"d1da3ad\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"mf-button.default\">\n\t\t\t\t\t\t\t<div className=\"mf-btn-wraper \" data-mf-form-conditional-logic-requirement=\"\">\r\n\t\t\t\t\t\t\t<button type=\"submit\" className=\"metform-btn metform-submit-btn \" id=\"\">\r\n\t\t\t\t\t<span>${ parent.decodeEntities(`Submit`) } <\/span>\r\n\t\t\t\t<\/button>\r\n\t\t\t        <\/div>\r\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t`}\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t${is_dummy_markup ? message_position === 'bottom' ? props.ResponseDummyMarkup(message_successIcon, message_proClass) : '' : ''}\r\n\t\t\t\t\t${is_dummy_markup ? ' ' : message_position === 'bottom' ? props.SubmitResponseMarkup`${parent}${state}${message_successIcon}${message_errorIcon}${message_proClass}` : ''}\r\n\t\t\t\t\r\n\t\t\t\t<\/form>\r\n\t\t\t`\r\n\t\t<\/script>\r\n\r\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\t\t\t\t<\/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":"<p>New Patient Registration Form Click Submit, and we will reach out to you soon.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-938","page","type-page","status-publish","hentry"],"acf":[],"_hostinger_reach_plugin_has_subscription_block":false,"_hostinger_reach_plugin_is_elementor":false,"_links":{"self":[{"href":"https:\/\/siteovia.com\/core\/wp-json\/wp\/v2\/pages\/938","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/siteovia.com\/core\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/siteovia.com\/core\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/siteovia.com\/core\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/siteovia.com\/core\/wp-json\/wp\/v2\/comments?post=938"}],"version-history":[{"count":13,"href":"https:\/\/siteovia.com\/core\/wp-json\/wp\/v2\/pages\/938\/revisions"}],"predecessor-version":[{"id":968,"href":"https:\/\/siteovia.com\/core\/wp-json\/wp\/v2\/pages\/938\/revisions\/968"}],"wp:attachment":[{"href":"https:\/\/siteovia.com\/core\/wp-json\/wp\/v2\/media?parent=938"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}