{"id":18,"date":"2016-03-03T09:08:43","date_gmt":"2016-03-03T09:08:43","guid":{"rendered":"http:\/\/localhost\/swansea\/?page_id=18"},"modified":"2023-06-08T10:33:16","modified_gmt":"2023-06-08T10:33:16","slug":"book-appt","status":"publish","type":"page","link":"https:\/\/swanseadentalcare.com\/es\/book-appt\/","title":{"rendered":"LIBRO APPT"},"content":{"rendered":"<p><\/p>\n<div class=\"contact-form\">\n<div class=\"formsection\">\n<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f261-o2\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/18#wpcf7-f261-o2\" method=\"post\" class=\"wpcf7-form\" novalidate=\"novalidate\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"261\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"4.4.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f261-o2\" \/>\n<input type=\"hidden\" name=\"_wpnonce\" value=\"0e206e692d\" \/>\n<\/div>\n<p>First Name *<br \/>\n<span class=\"wpcf7-form-control-wrap text-1\"><input type=\"text\" name=\"text-1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required texstyle\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/p>\n<p>Last Name *<br \/>\n<span class=\"wpcf7-form-control-wrap text-622\"><input type=\"text\" name=\"text-622\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required texstyle\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/p>\n<p>Email *<br \/>\n<span class=\"wpcf7-form-control-wrap email-921\"><input type=\"email\" name=\"email-921\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email texstyle\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/p>\n<p>Phone *<br \/>\n<span class=\"wpcf7-form-control-wrap tel-430\"><input type=\"tel\" name=\"tel-430\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel texstyle\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/p>\n<p>Address<br \/>\n<span class=\"wpcf7-form-control-wrap text-190\"><input type=\"text\" name=\"text-190\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text texstyle\" aria-invalid=\"false\" \/><\/span><\/p>\n<p>Zip code<br \/>\n<span class=\"wpcf7-form-control-wrap text-20\"><input type=\"text\" name=\"text-20\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text texstyle\" aria-invalid=\"false\" \/><\/span><\/p>\n<p>Appointment Type<\/p>\n<p><span class=\"wpcf7-form-control-wrap menu-778\"><select name=\"menu-778\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required texstyle\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"\">---<\/option><option value=\"Emergency Toothache\">Emergency Toothache<\/option><option value=\"New Patient Cleaning\">New Patient Cleaning<\/option><option value=\"Filling or Crown Needed\">Filling or Crown Needed<\/option><option value=\"Denture or Partial Repair\">Denture or Partial Repair<\/option><option value=\"Other\">Other<\/option><\/select><\/span><\/p>\n<p>Insurance Type<br \/>\n<span class=\"wpcf7-form-control-wrap insurance\"><select name=\"insurance\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required texstyle\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"\">---<\/option><option value=\"Blue Cross Blue Shield\">Blue Cross Blue Shield<\/option><option value=\"Cigna\">Cigna<\/option><option value=\"Delta Dental\">Delta Dental<\/option><option value=\"Humana\">Humana<\/option><option value=\"United Health Care\">United Health Care<\/option><option value=\"Other\">Other<\/option><option value=\"I do not have insurance\">I do not have insurance<\/option><\/select><\/span><\/p>\n<p>Comments<br \/>\n<span class=\"wpcf7-form-control-wrap textarea-769\"><textarea name=\"textarea-769\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea comstyle\" aria-invalid=\"false\"><\/textarea><\/span><\/p>\n<p><input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-1\" value=\"2156181259\" \/><img loading=\"lazy\" decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-1\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"https:\/\/swanseadentalcare.com\/wp-content\/uploads\/wpcf7_captcha\/2156181259.png\" \/><br \/>\n<span class=\"wpcf7-form-control-wrap captcha-1\"><input type=\"text\" name=\"captcha-1\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-captchar texstyle\" aria-invalid=\"false\" \/><\/span><\/p>\n<p><input type=\"submit\" value=\"SUBMIT\" class=\"wpcf7-form-control wpcf7-submit sub-btn\" \/><\/p>\n<div class=\"wpcf7-response-output wpcf7-display-none\"><\/div><\/form><\/div>\n<\/div>\n<div 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class=\"clear\"><\/div>\n<\/div>\n<p><\/p>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"ngg_post_thumbnail":0,"footnotes":""},"class_list":["post-18","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/swanseadentalcare.com\/es\/wp-json\/wp\/v2\/pages\/18","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/swanseadentalcare.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/swanseadentalcare.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/swanseadentalcare.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/swanseadentalcare.com\/es\/wp-json\/wp\/v2\/comments?post=18"}],"version-history":[{"count":28,"href":"https:\/\/swanseadentalcare.com\/es\/wp-json\/wp\/v2\/pages\/18\/revisions"}],"predecessor-version":[{"id":938,"href":"https:\/\/swanseadentalcare.com\/es\/wp-json\/wp\/v2\/pages\/18\/revisions\/938"}],"wp:attachment":[{"href":"https:\/\/swanseadentalcare.com\/es\/wp-json\/wp\/v2\/media?parent=18"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}