{"id":616,"date":"2024-06-15T13:42:56","date_gmt":"2024-06-15T13:42:56","guid":{"rendered":"https:\/\/www.saudementalitapema.com.br\/novo\/?page_id=616"},"modified":"2024-06-15T13:42:56","modified_gmt":"2024-06-15T13:42:56","slug":"appointment-form","status":"publish","type":"page","link":"https:\/\/www.saudementalitapema.com.br\/novo\/appointment-form\/","title":{"rendered":"Appointment Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"616\" class=\"elementor elementor-616\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-e0226a8 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"e0226a8\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;wdt_bg_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_laptop&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_tablet_extra&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_mobile_extra&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_position&quot;:&quot;center center&quot;,&quot;wdt_animation_effect&quot;:&quot;none&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-f43e56f\" data-id=\"f43e56f\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-04a284d before-title center elementor-invisible elementor-widget elementor-widget-wdt-heading\" data-id=\"04a284d\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;wdt_enable_inview_status&quot;:&quot;true&quot;,&quot;_animation&quot;:&quot;fadeInUp&quot;,&quot;_animation_delay&quot;:100,&quot;wdt_animation_effect&quot;:&quot;none&quot;}\" data-widget_type=\"wdt-heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wdt-heading-holder \" id=\"wdt-heading-04a284d\"><div class=\"wdt-heading-subtitle-wrapper wdt-heading-align-center wdt-heading-deco-wrapper\"><span class=\"wdt-heading-subtitle\"><span class=\"wdt-heading-deco-inner wdt-left-part\"><span class=\"wdt-heading-deco-icon\"><span class=\"wdt-content-icon-wrapper\"><span class=\"wdt-content-icon\"><span><i><svg xmlns=\"http:\/\/www.w3.org\/2000\/svg\" x=\"0px\" y=\"0px\" viewBox=\"0 0 100 81\" style=\"enable-background:new 0 0 100 81;\" xml:space=\"preserve\"><path d=\"M62.3,47.7c32.5-12.2,7.8-50.8-11.1-26.6c-8.1-16.2-30.6-6.7-24.5,12.6c6.5,20.6,26.2,28.6,45.6,25.9 c8.3-1.2,15.5-5.1,21-11.3c15.8-17.9-3.7-39.1-27.2-45.2c-61-15.9-91.5,54.3-35.9,67.2c0,0-0.5,1.4-1.6,4.2 c-1.9,4.9,3.5,8.9,8.4,1.6c4.1-6.1,7.9-10.2,11.4-12.3c-6.6,2.4-14.9,11.8-14.3,4.5C-21.7,55.1,11.3-7.4,64.3,6.6 c20,5.3,36.6,21.1,26.2,37.5c-6.4,10-15.1,12-26.6,12.2C21,57,25.9,2.4,51,27.1C71,8.7,79.2,32.3,62.3,47.7\"><\/path><\/svg><\/i><\/span><\/span><\/span><\/span><\/span>Reserve Today<span class=\"wdt-heading-deco-inner wdt-right-part\"><\/span><\/span><\/div><h2 class=\"wdt-heading-title-wrapper wdt-heading-align-center \"><span class=\"wdt-heading-title\">Book Your Session Now<\/span><\/h2><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-a04be22 elementor-section-full_width elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"a04be22\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;animation&quot;:&quot;fadeInUp&quot;,&quot;animation_delay&quot;:300,&quot;wdt_bg_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_laptop&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_tablet_extra&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_mobile_extra&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_position&quot;:&quot;center center&quot;,&quot;wdt_animation_effect&quot;:&quot;none&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-380ec4d\" data-id=\"380ec4d\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d0288fa center wdt-cus-appointment-form-tab elementor-widget elementor-widget-wdt-tabs\" data-id=\"d0288fa\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;icon_show&quot;:&quot;true&quot;,&quot;wdt_animation_effect&quot;:&quot;none&quot;}\" data-widget_type=\"wdt-tabs.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wdt-tabs-container wdt-layout-horizontal wdt-template-bordered wdt-icon-style-block\" data-class-items=\"wdt-layout-horizontal wdt-template-bordered wdt-icon-style-block\"><div class=\"wdt-tabs-list-wrapper\"><ul class=\"wdt-tabs-list\"><li><a href=\"#wdt-tabs-0\"><div class=\"wdt-content-title\">General<\/div><\/a><\/li><li><a href=\"#wdt-tabs-1\"><div class=\"wdt-content-title\">Periodic<\/div><\/a><\/li><li><a href=\"#wdt-tabs-2\"><div class=\"wdt-content-title\">Online<\/div><\/a><\/li><li><a href=\"#wdt-tabs-3\"><div class=\"wdt-content-title\">In-House<\/div><\/a><\/li><\/ul><\/div><div class=\"wdt-tabs-content-wrapper\"><div id=\"wdt-tabs-0\" class=\"wdt-tabs-content\"><style>.elementor-626 .elementor-element.elementor-element-d018aa1 > .elementor-widget-wrap > .elementor-widget:not(.elementor-widget__width-auto):not(.elementor-widget__width-initial):not(:last-child):not(.elementor-absolute){--kit-widget-spacing:0px;}<\/style>\t\t<div data-elementor-type=\"page\" data-elementor-id=\"626\" class=\"elementor elementor-626\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4388e37 elementor-section-full_width elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"4388e37\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;animation&quot;:&quot;fadeInUp&quot;,&quot;wdt_bg_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_laptop&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_tablet_extra&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_mobile_extra&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_position&quot;:&quot;center center&quot;,&quot;wdt_animation_effect&quot;:&quot;none&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d018aa1\" data-id=\"d018aa1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-48cd19a elementor-widget elementor-widget-shortcode\" data-id=\"48cd19a\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;wdt_animation_effect&quot;:&quot;none&quot;}\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f623-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"623\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/novo\/wp-json\/wp\/v2\/pages\/616#wpcf7-f623-o1\" method=\"post\" class=\"wpcf7-form init wdt-appointment-details demo\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"623\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f623-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"patient-details\">\n\t<h4>Patient Details*\n\t<\/h4>\n\t<div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First name*\" value=\"\" type=\"text\" name=\"text\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name*\" value=\"\" type=\"text\" name=\"text\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Age*\" value=\"\" type=\"text\" name=\"text\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Mobile number*\" value=\"\" type=\"tel\" name=\"tel\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email address*\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Addresss\" value=\"\" type=\"text\" name=\"address\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"appointment-details\">\n\t<h4>Appointment Details*\n\t<\/h4>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"services\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"services\"><option value=\"How can we help you ?\">How can we help you ?<\/option><option value=\"Individual Counseling\">Individual Counseling<\/option><option value=\"Couples Counseling\">Couples Counseling<\/option><option value=\"Family Counseling\">Family Counseling<\/option><option value=\"Group Therapy\">Group Therapy<\/option><\/select><\/span><label><span>Location<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Location\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"Location\"><option value=\"Los Angles, CA\">Los Angles, CA<\/option><option value=\"New Zealand H.O.\">New Zealand H.O.<\/option><option value=\"Baltimore, MD\">Baltimore, MD<\/option><option value=\"Joanna, Australia\">Joanna, Australia<\/option><option value=\"New Hampshire, Terryville\">New Hampshire, Terryville<\/option><\/select><\/span><i class=\"wp-manasu-location-pin-icon\"><\/i><\/label><label class=\"appointment-date\"><span>Appointment Date*<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"date-137\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Select Date*\" value=\"\" type=\"date\" name=\"date-137\" \/><\/span><i class=\"wp-manasu-calendar-icon\"><\/i><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"textarea\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Additional Message\" name=\"textarea\"><\/textarea><\/span><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Book an appointment\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t<\/div><div id=\"wdt-tabs-1\" class=\"wdt-tabs-content\"><style>.elementor-626 .elementor-element.elementor-element-d018aa1 > .elementor-widget-wrap > .elementor-widget:not(.elementor-widget__width-auto):not(.elementor-widget__width-initial):not(:last-child):not(.elementor-absolute){--kit-widget-spacing:0px;}<\/style>\t\t<div data-elementor-type=\"page\" data-elementor-id=\"626\" class=\"elementor elementor-626\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4388e37 elementor-section-full_width elementor-section-height-default elementor-section-height-default elementor-invisible\" data-id=\"4388e37\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;animation&quot;:&quot;fadeInUp&quot;,&quot;wdt_bg_image&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_laptop&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_tablet_extra&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_tablet&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_mobile_extra&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_image_mobile&quot;:{&quot;url&quot;:&quot;&quot;,&quot;id&quot;:&quot;&quot;,&quot;size&quot;:&quot;&quot;},&quot;wdt_bg_position&quot;:&quot;center center&quot;,&quot;wdt_animation_effect&quot;:&quot;none&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d018aa1\" data-id=\"d018aa1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-48cd19a elementor-widget elementor-widget-shortcode\" data-id=\"48cd19a\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;wdt_animation_effect&quot;:&quot;none&quot;}\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f623-o2\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"623\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/novo\/wp-json\/wp\/v2\/pages\/616#wpcf7-f623-o2\" method=\"post\" class=\"wpcf7-form init wdt-appointment-details demo\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"623\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f623-o2\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"patient-details\">\n\t<h4>Patient Details*\n\t<\/h4>\n\t<div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First name*\" value=\"\" type=\"text\" name=\"text\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name*\" value=\"\" type=\"text\" name=\"text\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Age*\" value=\"\" type=\"text\" name=\"text\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Mobile number*\" value=\"\" type=\"tel\" name=\"tel\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Email address*\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"address\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Addresss\" value=\"\" type=\"text\" name=\"address\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n<\/div>\n<div class=\"appointment-details\">\n\t<h4>Appointment Details*\n\t<\/h4>\n\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"services\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"services\"><option value=\"How can we help you ?\">How can we help you ?<\/option><option value=\"Individual Counseling\">Individual Counseling<\/option><option value=\"Couples Counseling\">Couples Counseling<\/option><option value=\"Family Counseling\">Family Counseling<\/option><option value=\"Group Therapy\">Group Therapy<\/option><\/select><\/span><label><span>Location<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"Location\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"Location\"><option value=\"Los Angles, CA\">Los Angles, CA<\/option><option value=\"New Zealand H.O.\">New Zealand H.O.<\/option><option value=\"Baltimore, MD\">Baltimore, MD<\/option><option value=\"Joanna, Australia\">Joanna, Australia<\/option><option value=\"New Hampshire, Terryville\">New Hampshire, Terryville<\/option><\/select><\/span><i class=\"wp-manasu-location-pin-icon\"><\/i><\/label><label class=\"appointment-date\"><span>Appointment Date*<\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"date-137\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Select Date*\" value=\"\" type=\"date\" name=\"date-137\" \/><\/span><i class=\"wp-manasu-calendar-icon\"><\/i><\/label><span class=\"wpcf7-form-control-wrap\" data-name=\"textarea\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" placeholder=\"Additional Message\" name=\"textarea\"><\/textarea><\/span><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Book an appointment\" \/>\n\t<\/p>\n<\/div><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<\/div>\n\t\t<\/div><div id=\"wdt-tabs-2\" class=\"wdt-tabs-content\"><style>.elementor-626 .elementor-element.elementor-element-d018aa1 > .elementor-widget-wrap > 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class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-d018aa1\" data-id=\"d018aa1\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-48cd19a elementor-widget elementor-widget-shortcode\" data-id=\"48cd19a\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;wdt_animation_effect&quot;:&quot;none&quot;}\" data-widget_type=\"shortcode.default\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\">\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f623-o3\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"623\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/novo\/wp-json\/wp\/v2\/pages\/616#wpcf7-f623-o3\" method=\"post\" class=\"wpcf7-form init wdt-appointment-details demo\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"623\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.4\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f623-o3\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<div class=\"patient-details\">\n\t<h4>Patient Details*\n\t<\/h4>\n\t<div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First name*\" value=\"\" type=\"text\" name=\"text\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name*\" value=\"\" type=\"text\" name=\"text\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Age*\" value=\"\" type=\"text\" name=\"text\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Mobile number*\" value=\"\" type=\"tel\" name=\"tel\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email 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class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last Name*\" value=\"\" type=\"text\" name=\"text\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"text\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Age*\" value=\"\" type=\"text\" name=\"text\" \/><\/span>\n\t\t<\/p>\n\t<\/div>\n\t<div>\n\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"tel\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Mobile number*\" value=\"\" type=\"tel\" name=\"tel\" \/><\/span><span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email 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