{"id":104,"date":"2022-12-28T23:56:01","date_gmt":"2022-12-29T04:56:01","guid":{"rendered":"https:\/\/eaomonsey.com\/?page_id=104"},"modified":"2023-01-21T19:24:42","modified_gmt":"2023-01-22T00:24:42","slug":"refer-a-patient-for-doctors","status":"publish","type":"page","link":"https:\/\/eaomonsey.com\/refer-a-patient-for-doctors\/","title":{"rendered":"Refer a Patient \u2013 For Doctors"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"104\" class=\"elementor elementor-104\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c57e6fb e-flex e-con-boxed e-con e-parent\" data-id=\"c57e6fb\" 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-79e0b45 elementor-widget elementor-widget-text-editor\" data-id=\"79e0b45\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor - v3.21.0 - 25-04-2024 *\/\n.elementor-widget-text-editor.elementor-drop-cap-view-stacked .elementor-drop-cap{background-color:#69727d;color:#fff}.elementor-widget-text-editor.elementor-drop-cap-view-framed .elementor-drop-cap{color:#69727d;border:3px solid;background-color:transparent}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap{margin-top:8px}.elementor-widget-text-editor:not(.elementor-drop-cap-view-default) .elementor-drop-cap-letter{width:1em;height:1em}.elementor-widget-text-editor .elementor-drop-cap{float:left;text-align:center;line-height:1;font-size:50px}.elementor-widget-text-editor .elementor-drop-cap-letter{display:inline-block}<\/style>\t\t\t\t<p>A successful practice doesn\u2019t just happen; it is the result of a strong commitment to excellence in the professional community and in the relationships we build with our patients and colleagues. We appreciate the confidence you\u2019ve placed in us to provide you with the complete care you need, and we thank you for recommending our practice to your friends and family.<\/p><p>If you are here to refer a patient to our practice, please provide us with the information below. Once you\u2019ve completed the form, click on the SUBMIT button at the bottom of the page.<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-229a7b6 elementor-button-align-stretch elementor-widget elementor-widget-form\" data-id=\"229a7b6\" data-element_type=\"widget\" data-settings=\"{&quot;step_next_label&quot;:&quot;Next&quot;,&quot;step_previous_label&quot;:&quot;Previous&quot;,&quot;button_width&quot;:&quot;100&quot;,&quot;step_type&quot;:&quot;number_text&quot;,&quot;step_icon_shape&quot;:&quot;circle&quot;}\" data-widget_type=\"form.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<style>\/*! elementor-pro - v3.21.0 - 24-04-2024 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elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-name\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tDoctor Name:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[name]\" id=\"form-field-name\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-text elementor-field-group elementor-column elementor-field-group-field_f125a1e elementor-col-50 elementor-md-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_f125a1e\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPractice Name:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_f125a1e]\" id=\"form-field-field_f125a1e\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" 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Referring:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"text\" name=\"form_fields[field_ae34d37]\" id=\"form-field-field_ae34d37\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-tel elementor-field-group elementor-column elementor-field-group-field_4db53da elementor-col-50 elementor-md-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_4db53da\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient's Phone Number:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t<input size=\"1\" type=\"tel\" name=\"form_fields[field_4db53da]\" id=\"form-field-field_4db53da\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\" pattern=\"[0-9()#&amp;+*-=.]+\" title=\"Only numbers and phone characters (#, -, *, etc) are accepted.\">\n\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-email elementor-field-group elementor-column elementor-field-group-field_2fd5a5f elementor-col-50 elementor-md-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_2fd5a5f\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tPatient's Email Address:\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t<input size=\"1\" type=\"email\" name=\"form_fields[field_2fd5a5f]\" id=\"form-field-field_2fd5a5f\" class=\"elementor-field elementor-size-md  elementor-field-textual\" required=\"required\" aria-required=\"true\">\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-radio elementor-field-group elementor-column elementor-field-group-field_d672baa elementor-col-100 elementor-md-50 elementor-field-required\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-field_d672baa\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tRadiographs Sent?\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<div class=\"elementor-field-subgroup  elementor-subgroup-inline\"><span class=\"elementor-field-option\"><input type=\"radio\" value=\"Yes\" id=\"form-field-field_d672baa-0\" name=\"form_fields[field_d672baa]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_d672baa-0\">Yes<\/label><\/span><span class=\"elementor-field-option\"><input type=\"radio\" value=\"No\" id=\"form-field-field_d672baa-1\" name=\"form_fields[field_d672baa]\" required=\"required\" aria-required=\"true\"> <label for=\"form-field-field_d672baa-1\">No<\/label><\/span><\/div>\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<div class=\"elementor-field-type-textarea elementor-field-group elementor-column elementor-field-group-message elementor-col-100\">\n\t\t\t\t\t\t\t\t\t\t\t\t<label for=\"form-field-message\" class=\"elementor-field-label\">\n\t\t\t\t\t\t\t\tComments\t\t\t\t\t\t\t<\/label>\n\t\t\t\t\t\t<textarea class=\"elementor-field-textual elementor-field  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We appreciate the confidence you\u2019ve placed in us to provide you with the complete care you need, and we thank you for recommending our [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_seopress_robots_primary_cat":"","_seopress_titles_title":"","_seopress_titles_desc":"","_seopress_robots_index":"","inline_featured_image":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/eaomonsey.com\/wp-json\/wp\/v2\/pages\/104"}],"collection":[{"href":"https:\/\/eaomonsey.com\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/eaomonsey.com\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/eaomonsey.com\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/eaomonsey.com\/wp-json\/wp\/v2\/comments?post=104"}],"version-history":[{"count":58,"href":"https:\/\/eaomonsey.com\/wp-json\/wp\/v2\/pages\/104\/revisions"}],"predecessor-version":[{"id":3278,"href":"https:\/\/eaomonsey.com\/wp-json\/wp\/v2\/pages\/104\/revisions\/3278"}],"wp:attachment":[{"href":"https:\/\/eaomonsey.com\/wp-json\/wp\/v2\/media?parent=104"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}