{"id":568,"date":"2025-05-21T13:02:14","date_gmt":"2025-05-21T13:02:14","guid":{"rendered":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/?page_id=568"},"modified":"2025-05-30T10:47:43","modified_gmt":"2025-05-30T10:47:43","slug":"make-an-appointment","status":"publish","type":"page","link":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/make-an-appointment\/","title":{"rendered":"Make an Appointment"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"568\" class=\"elementor elementor-568\">\n\t\t\t\t<div class=\"elementor-element elementor-element-30b599e e-flex e-con-boxed e-con e-parent\" data-id=\"30b599e\" data-element_type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-7a3cb96 elementor-widget elementor-widget-heading\" data-id=\"7a3cb96\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Make an Appointment<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4bf63e0 elementor-icon-list--layout-inline elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"4bf63e0\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items elementor-inline-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Home<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item elementor-inline-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<svg aria-hidden=\"true\" class=\"e-font-icon-svg e-fas-circle\" viewBox=\"0 0 512 512\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M256 8C119 8 8 119 8 256s111 248 248 248 248-111 248-248S393 8 256 8z\"><\/path><\/svg>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Make an Appointment<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\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<div class=\"elementor-element elementor-element-73fb941 e-flex e-con-boxed e-con e-parent\" data-id=\"73fb941\" 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-6d05244 elementor-widget elementor-widget-metform\" data-id=\"6d05244\" data-element_type=\"widget\" data-widget_type=\"metform.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div id=\"mf-response-props-id-549\" 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=\"549\" >\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-6d05244-549\"\r\n\t\t\tclass=\"mf-form-wrapper\"\r\n\t\t\tdata-form-id=\"549\"\r\n\t\t\tdata-action=\"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/metform\/v1\/entries\/insert\/549\"\r\n\t\t\tdata-wp-nonce=\"becba3e160\"\r\n\t\t\tdata-form-nonce=\"c9a87d7ede\"\r\n\t\t\tdata-quiz-summery = \"false\"\r\n\t\t\tdata-save-progress = \"false\"\r\n\t\t\tdata-form-type=\"contact_form\"\r\n\t\t\tdata-stop-vertical-effect=\"\"\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-549\";\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=\"549\" className=\"elementor elementor-549\">\n\t\t\t\t<div className=\"elementor-element elementor-element-8a55b49 e-flex e-con-boxed e-con e-parent\" data-id=\"8a55b49\" data-element_type=\"container\">\n\t\t\t\t\t<div className=\"e-con-inner\">\n\t\t\t\t<div className=\"elementor-element elementor-element-cce5377 elementor-widget elementor-widget-heading\" data-id=\"cce5377\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t<h2 className=\"elementor-heading-title elementor-size-default\">Request to be Contacted to Schedule an Appointment<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-4a740cf elementor-widget elementor-widget-text-editor\" data-id=\"4a740cf\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>For <strong>NEW<\/strong> or returning patients requesting to be contacted to schedule an appointment, please use the form below. A scheduling representative will respond to your request within 24 to 48 hours upon receipt.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-35be057 elementor-widget elementor-widget-heading\" data-id=\"35be057\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t<h3 className=\"elementor-heading-title elementor-size-default\">Patient Information<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-4cdd628 e-con-full e-flex e-con e-child\" data-id=\"4cdd628\" data-element_type=\"container\">\n\t\t\t\t<div className=\"elementor-element elementor-element-cf12dee elementor-widget__width-initial elementor-widget elementor-widget-mf-text\" data-id=\"cf12dee\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\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-text-cf12dee\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Legal First Name `) } \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<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-cf12dee\"\r\n\t\t\t\tname=\"mf-text\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${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=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${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>\n\t\t\t\t<div className=\"elementor-element elementor-element-8c64076 elementor-widget__width-initial elementor-widget elementor-widget-mf-text\" data-id=\"8c64076\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\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-text-8c64076\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Legal Last Name `) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<input\r\n\t\t\t\ttype=\"text\"\r\n\t\t\t\tclassName=\"mf-input \"\r\n\t\t\t\tid=\"mf-input-text-8c64076\"\r\n\t\t\t\tname=\"mf-text\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\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\":true,\"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=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\r\n\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-c6f496c elementor-widget__width-initial elementor-widget elementor-widget-mf-email\" data-id=\"c6f496c\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-email&quot;}\" data-widget_type=\"mf-email.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-email-c6f496c\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Email`) } \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<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-c6f496c\" \r\n\t\t\t\tname=\"mf-email\" \r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \" \r\n\t\t\t\t \r\n\t\t\t\tonBlur=${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>\n\t\t\t\t<div className=\"elementor-element elementor-element-7b1b777 elementor-widget__width-initial elementor-widget elementor-widget-mf-telephone\" data-id=\"7b1b777\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-telephone&quot;}\" data-widget_type=\"mf-telephone.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-telephone-7b1b777\">\n\t\t\t\t\t${ parent.decodeEntities(`Home or Mobile Number`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n\t\t\t\n\t\t\t<input\n\t\t\t\ttype=\"tel\"\n\t\t\t\tclassName=\"mf-input \"\n\t\t\t\tid=\"mf-input-telephone-7b1b777\" \n\t\t\t\tname=\"mf-telephone\"\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\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=${el => parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\n\t\t\t\t\t\t\t\t\/>\n\t\t\t\n\t\t\t\t\t\t\t<${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>\n\t\t\t\t<div className=\"elementor-element elementor-element-b27835d elementor-widget__width-initial elementor-widget elementor-widget-mf-date\" data-id=\"b27835d\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-date&quot;}\" data-widget_type=\"mf-date.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\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-date-b27835d\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Date of Birth`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<${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=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\toptions=${{\"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\":true},  \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=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-0491e06 elementor-widget__width-initial elementor-widget elementor-widget-mf-select\" data-id=\"0491e06\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-select&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;New consultation&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;f4100dc&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Follow-up appointment&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;aa77c4b&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Injection request&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;db9ddb0&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Workers Comp&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;9457d9b&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-select.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-0491e06\">\n\t\t\t\t\t${ parent.decodeEntities(`Type of Appointment Requesting `) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \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=\"${ parent.decodeEntities(``) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"New consultation\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Follow-up appointment\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Injection request\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Workers Comp\",\"value\":\"value-3\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select\") ? [{\"label\":\"New consultation\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Follow-up appointment\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Injection request\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Workers Comp\",\"value\":\"value-3\",\"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\":true}));\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\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-3e66dc6 elementor-widget elementor-widget-heading\" data-id=\"3e66dc6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t<h3 className=\"elementor-heading-title elementor-size-default\">About Your Appointment Request<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div className=\"elementor-element elementor-element-412edd2 e-con-full e-flex e-con e-child\" data-id=\"412edd2\" data-element_type=\"container\">\n\t\t\t\t<div className=\"elementor-element elementor-element-3dd7400 elementor-widget elementor-widget-mf-select\" data-id=\"3dd7400\" data-element_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;Knee&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;ee10f2b&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Elbow&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;eba29a7&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Shoulder&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;d8ab29b&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Back \\\/ Spine&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;39d4467&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Sports Medicine&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;ce01864&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<div className=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-3dd7400\">\n\t\t\t\t\t${ parent.decodeEntities(`What body part is injured, experiencing discomfort or illness? `) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \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=\"${ parent.decodeEntities(``) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Knee\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Elbow\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Shoulder\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Back \\\/ Spine\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Sports Medicine\",\"value\":\"value-3\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select\") ? [{\"label\":\"Knee\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Elbow\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Shoulder\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Back \\\/ Spine\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Sports Medicine\",\"value\":\"value-3\",\"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\":true}));\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=${html`<span className=\"mf-error-message\"><\/span>`}\n\t\t\t\t\t\/>\n\t\t\t\t\t\t\t\t<\/div>\n\n\t\t\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-96bcfb9 elementor-widget elementor-widget-mf-text\" data-id=\"96bcfb9\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-text&quot;}\" data-widget_type=\"mf-text.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\r\n\t\t<div className=\"mf-input-wrapper\">\r\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-text-96bcfb9\">\r\n\t\t\t\t\t${ parent.decodeEntities(`Briefly tell us about your injury`) } \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<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-96bcfb9\"\r\n\t\t\t\tname=\"mf-text\"\r\n\t\t\t\tplaceholder=\"${ parent.decodeEntities(``) } \"\r\n\t\t\t\t\t\t\t\t\tonInput=${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=${el =>{\r\n\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)\r\n\t\t\t\t\t}}\r\n\t\t\t\t\t\t\t\t\/>\r\n\r\n\t\t\t\t\t\t\t<${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>\n\t\t\t\t<div className=\"elementor-element elementor-element-ba89708 elementor-widget elementor-widget-mf-select\" data-id=\"ba89708\" data-element_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;Daniel Kharrazi, MD&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;3c124a9&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Jae H. Chon, MD&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;12061d2&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Ronald S. Kvitne, MD&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;18216e6&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<div className=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-ba89708\">\n\t\t\t\t\t${ parent.decodeEntities(`Preferred Physician`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \n            <${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(``) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"Daniel Kharrazi, MD\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Jae H. Chon, MD\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Ronald S. Kvitne, MD\",\"value\":\"value-3\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select\") ? [{\"label\":\"Daniel Kharrazi, MD\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"Jae H. Chon, MD\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Ronald S. Kvitne, MD\",\"value\":\"value-3\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true}));\n                    if ( parent.getValue(\"mf-select\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${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\t\t<div className=\"elementor-element elementor-element-e3da911 elementor-widget elementor-widget-mf-select\" data-id=\"e3da911\" data-element_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;EPO&quot;,&quot;mf_input_option_value&quot;:&quot;value-1&quot;,&quot;_id&quot;:&quot;3c124a9&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;PPO&quot;,&quot;mf_input_option_value&quot;:&quot;value-2&quot;,&quot;_id&quot;:&quot;12061d2&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Medicare&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;18216e6&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;HMO&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;7e2291f&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;Medi-Cal&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;75a95ed&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;CASH patient&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;8e161d0&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-3&quot;,&quot;_id&quot;:&quot;59f64d4&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<div className=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-e3da911\">\n\t\t\t\t\t${ parent.decodeEntities(`Identify your Insurance type`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \n            <${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(``) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"EPO\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"PPO\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Medicare\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"HMO\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Medi-Cal\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"CASH patient\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Other\",\"value\":\"value-3\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select\") ? [{\"label\":\"EPO\",\"value\":\"value-1\",\"isDisabled\":false},{\"label\":\"PPO\",\"value\":\"value-2\",\"isDisabled\":false},{\"label\":\"Medicare\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"HMO\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Medi-Cal\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"CASH patient\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"Other\",\"value\":\"value-3\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true}));\n                    if ( parent.getValue(\"mf-select\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${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\t\t<div className=\"elementor-element elementor-element-698af68 elementor-widget elementor-widget-mf-select\" data-id=\"698af68\" data-element_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;YES&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;75a95ed&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-3&quot;,&quot;_id&quot;:&quot;8e161d0&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;},{&quot;mf_input_option_text&quot;:&quot;I don&#039;t know&quot;,&quot;mf_input_option_value&quot;:&quot;value-3&quot;,&quot;_id&quot;:&quot;59f64d4&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<div className=\"elementor-widget-container\">\n\t\t\t\t\t\n\t\t\n\t\t<div className=\"mf-input-wrapper\">\n\t\t\t\t\t\t\t<label className=\"mf-input-label\" htmlFor=\"mf-input-select-698af68\">\n\t\t\t\t\t${ parent.decodeEntities(`Do you have Secondary Insurance?`) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\n\t\t\t\t<\/label>\n            \n            <${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(``) } \"\n                isSearchable=${false}\n                options=${[{\"label\":\"YES\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"NO\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"I don't know\",\"value\":\"value-3\",\"isDisabled\":false}]}\n                value=${parent.getValue(\"mf-select\") ? [{\"label\":\"YES\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"NO\",\"value\":\"value-3\",\"isDisabled\":false},{\"label\":\"I don't know\",\"value\":\"value-3\",\"isDisabled\":false}].filter(item => item.value === parent.getValue(\"mf-select\"))[0] : []}\n                onChange=${(e)=> parent.handleSelect(e, \"mf-select\")}\n                ref=${() => {\n\t\t\t\t                    register({ name: \"mf-select\" }, parent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true}));\n                    if ( parent.getValue(\"mf-select\") === '' && false ) {\n\t\t\t\t    parent.setValue( 'mf-select', '', true );\n                        parent.handleChange({\n                            target: {\n                                name: 'mf-select',\n                                value: ''\n                            }\n                        });\n                    }\n                }}\n                \/>\n\n            \t\t\t\t<${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\t\t<div className=\"elementor-element elementor-element-c6d784d elementor-widget elementor-widget-text-editor\" data-id=\"c6d784d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p className=\"\" data-start=\"82\" data-end=\"401\">Kerlan-Jobe Institute will not be held responsible in the event your electronic message is not transmitted due to technical problems related to this site or to the hosting server. All personally identifying information is encrypted and your message will not be internally or externally forwarded to other third parties.<\/p><p className=\"\" data-start=\"403\" data-end=\"516\">Your request will generally be processed within 24 to 48 hours, during normal business hours, excluding holidays.<\/p><p className=\"\" data-start=\"518\" data-end=\"616\">If you do not accept these terms, you will not be able to process your request and\/or form online.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-180c66f accept-box elementor-widget elementor-widget-mf-checkbox\" data-id=\"180c66f\" data-element_type=\"widget\" data-settings=\"{&quot;mf_input_name&quot;:&quot;mf-checkbox&quot;,&quot;mf_input_list&quot;:[{&quot;mf_input_option_text&quot;:&quot;I agree&quot;,&quot;mf_input_option_value&quot;:&quot;accept-box&quot;,&quot;_id&quot;:&quot;7c8b641&quot;,&quot;mf_input_option_status&quot;:&quot;&quot;,&quot;mf_input_option_selected&quot;:&quot;&quot;}]}\" data-widget_type=\"mf-checkbox.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\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-checkbox-180c66f\">\r\n\t\t\t\t\t${ parent.decodeEntities(`If you do not accept these terms, please call us at 1-800-CEDARS-1 for assistance with your request. * `) } \t\t\t\t\t<span className=\"mf-input-required-indicator\">*<\/span>\r\n\t\t\t\t<\/label>\r\n\t\t\t\r\n\t\t\t<div \r\n\t\t\t\t\t\t\t\t\tref=${el => parent.handleCheckbox(el, 'onLoad')}\r\n\t\t\t\t\t\t\t\t\tclassName=\"mf-checkbox multi-option-input-type\"\r\n\t\t\t\t\tid=\"mf-input-checkbox-180c66f\">\r\n\t\t\t\t\t\t\t\t\t<div className=\"mf-checkbox-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 type=\"checkbox\"\r\n\t\t\t\t\t\t\t\tclassName=\"mf-input mf-checkbox-input \"\r\n\t\t\t\t\t\t\t\tname=\"mf-checkbox\"\r\n\t\t\t\t\t\t\t\tvalue=\"accept-box\"\r\n\t\t\t\t\t\t\t\tdefaultChecked=\"\"\r\n\t\t\t\t\t\t\t\t\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\tonInput=${ el =>  parent.handleCheckbox(el.target, 'onClick') }\r\n\t\t\t\t\t\t\t\t\taria-invalid=${validation.errors['mf-checkbox'] ? 'true' : 'false'}\r\n\t\t\t\t\t\t\t\t\tref=${el => {\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tparent.activateValidation({\"message\":\"This field is required.\",\"minLength\":1,\"maxLength\":\"\",\"type\":\"none\",\"required\":true,\"expression\":\"null\"}, el)}\r\n\t\t\t\t\t\t\t\t\t}\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t<span>\r\n\t\t\t\t\t\t\t\t${ parent.decodeEntities(`I agree`) } \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\t\t\t<input type=\"hidden\" name=\"mf-checkbox\" value=\"\" \/>\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-checkbox\"\r\n\t\t\t\t\tas=${html`<span className=\"mf-error-message\"><\/span>`}\r\n\t\t\t\t\t\/>\r\n\t\t\t\t\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div className=\"elementor-element elementor-element-7989b12 mf-btn--left elementor-widget elementor-widget-mf-button\" data-id=\"7989b12\" data-element_type=\"widget\" data-widget_type=\"mf-button.default\">\n\t\t\t\t<div className=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div className=\"mf-btn-wraper \" data-mf-form-conditional-logic-requirement=\"\">\r\n\t\t\t\t\t\t\t<button type=\"submit\" className=\"metform-btn metform-submit-btn \" id=\"\">\r\n\t\t\t\t\t<span>${ 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\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\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Make an Appointment Home Make an Appointment<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"elementor_header_footer","meta":{"footnotes":""},"class_list":["post-568","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/wp\/v2\/pages\/568","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/wp\/v2\/comments?post=568"}],"version-history":[{"count":10,"href":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/wp\/v2\/pages\/568\/revisions"}],"predecessor-version":[{"id":1151,"href":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/wp\/v2\/pages\/568\/revisions\/1151"}],"wp:attachment":[{"href":"https:\/\/web.ifoxsolutions.com\/kerlanjobe\/wp-json\/wp\/v2\/media?parent=568"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}