{"id":686,"date":"2018-11-15T10:04:55","date_gmt":"2018-11-15T10:04:55","guid":{"rendered":"http:\/\/elajmedicalcentre.ae\/ar\/?page_id=686"},"modified":"2020-01-26T17:48:37","modified_gmt":"2020-01-26T17:48:37","slug":"appointment-form","status":"publish","type":"page","link":"https:\/\/elajmedicalcentre.ae\/ar\/appointment-form\/","title":{"rendered":"Appointment Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"686\" class=\"elementor elementor-686\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a9ecbdd elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"a9ecbdd\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-db5e03d bg-primary\" data-id=\"db5e03d\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-83e542d elementor-widget elementor-widget-rt-title\" data-id=\"83e542d\" data-element_type=\"widget\" data-widget_type=\"rt-title.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"section-heading heading-dark text-left heading-layout1\">\n        <h2 class=\"rtin-title\">\u0625\u062d\u062c\u0632 \u0645\u0648\u0639\u062f<\/h2>\n         <\/div>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-be62598 elementor-widget elementor-widget-shortcode\" data-id=\"be62598\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\"><div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f711-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\" role=\"alert\" aria-live=\"polite\"><\/div>\n<form action=\"\/ar\/wp-json\/wp\/v2\/pages\/686#wpcf7-f711-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"711\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.2.2\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f711-o1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/>\n<input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/div>\n<div class=\"appointment-box-layout1\">\n<div class=\"row gutters-15\">\n<div class=\"col-12 form-group\">\n<span class=\"wpcf7-form-control-wrap department\"><select name=\"department\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required select2\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"Select Department\">Select Department<\/option><option value=\"Cardiology &amp; Internal Medicine\">Cardiology &amp; Internal Medicine<\/option><option value=\"Cupping\">Cupping<\/option><option value=\"Dentistry\">Dentistry<\/option><option value=\"Dermatology\">Dermatology<\/option><option value=\"ENT\">ENT<\/option><option value=\"FRACTIONAL LASER\">FRACTIONAL LASER<\/option><option value=\"GASTROENTEROLOGY\">GASTROENTEROLOGY<\/option><option value=\"General Medicine\">General Medicine<\/option><option value=\"Gynecology &amp; Obstetrics\">Gynecology &amp; Obstetrics<\/option><option value=\"Juliet The Feminine Laser\">Juliet The Feminine Laser<\/option><option value=\"Laboratory\">Laboratory<\/option><option value=\"Neurology\">Neurology<\/option><option value=\"New Laser Machine (DUETTO MT)\">New Laser Machine (DUETTO MT)<\/option><option value=\"Ophthalmology\">Ophthalmology<\/option><option value=\"ORTHODONTIST\">ORTHODONTIST<\/option><option value=\"Orthopedics\">Orthopedics<\/option><option value=\"PATHOLOGY\">PATHOLOGY<\/option><option value=\"Psychiatry\">Psychiatry<\/option><option value=\"Radiology\">Radiology<\/option><option value=\"Surgery\">Surgery<\/option><option value=\"ULTRALIFT (HIFU)\">ULTRALIFT (HIFU)<\/option><option value=\"Urology\">Urology<\/option><\/select><\/span>\n<\/div>\n<p><!--div class=\"col-12 form-group\"><br \/>\n<span class=\"wpcf7-form-control-wrap doctor\"><select name=\"doctor\" class=\"wpcf7-form-control wpcf7-select select2\" aria-invalid=\"false\"><option value=\"Choose Doctor by Name\">Choose Doctor by Name<\/option><option value=\"DR. ASMAA MOHAMMED ABDELMAGED ABDELAAL\">DR. ASMAA MOHAMMED ABDELMAGED ABDELAAL<\/option><option value=\"MS. HANIA JARDI\">MS. HANIA JARDI<\/option><option value=\"DR. WASEEM MOSTAFA MAHOUL\">DR. WASEEM MOSTAFA MAHOUL<\/option><option value=\"DR. MOHAMAD WAHID DAQAQ\">DR. MOHAMAD WAHID DAQAQ<\/option><option value=\"DR. TARIQ ALMUSHARAF\">DR. TARIQ ALMUSHARAF<\/option><option value=\"DR. ARWA ODEH\">DR. ARWA ODEH<\/option><option value=\"\"><\/option><option value=\"\"><\/option><option value=\"\"><\/option><\/select><\/span>\n<\/div-->\n<div class=\"col-12 form-group\">\n<span class=\"wpcf7-form-control-wrap form-name\"><input type=\"text\" name=\"form-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u0627\u0633\u0645 \u0627\u0644\u0645\u0631\u064a\u0636 *\" \/><\/span>\n<\/div>\n<div class=\"col-md-6 form-group\">\n<span class=\"wpcf7-form-control-wrap form-name\"><input type=\"text\" name=\"form-name\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u0627\u0644\u062a\u0644\u064a\u0641\u0648\u0646 \u0627\u0644\u0645\u062d\u0645\u0648\u0644 *\" \/><\/span>\n<\/div>\n<div class=\"col-md-6 form-group\">\n<span class=\"wpcf7-form-control-wrap email\"><input type=\"email\" name=\"email\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u0627\u0644\u0628\u0631\u064a\u062f \u0627\u0644\u0625\u0644\u0643\u062a\u0631\u0648\u0646\u064a *\" \/><\/span>\n<\/div>\n<div class=\"col-sm-6 form-group\">\n<span class=\"wpcf7-form-control-wrap date\"><input type=\"date\" name=\"date\" value=\"\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-date form-control rt-date\" aria-invalid=\"false\" \/><\/span>\n<\/div>\n<div class=\"col-sm-6 form-group\">\n<span class=\"wpcf7-form-control-wrap time\"><input type=\"text\" name=\"time\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required form-control\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"\u0632\u0645\u0646*\" \/><\/span>\n<\/div>\n<div class=\"col-12 form-group\">\n<span class=\"wpcf7-form-control-wrap message\"><textarea name=\"message\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea textarea form-control\" aria-invalid=\"false\" placeholder=\"\u0631\u0633\u0627\u0644\u0629\"><\/textarea><\/span>\n<\/div>\n<div class=\"col-12 form-group\">\n<input type=\"submit\" value=\"\u0623\u0631\u0633\u0644\" class=\"wpcf7-form-control wpcf7-submit item-btn\" \/>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"wpcf7-response-output\" role=\"alert\" aria-hidden=\"true\"><\/div><\/form><\/div><\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/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<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-7969598\" data-id=\"7969598\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-0a22211 elementor-widget elementor-widget-image\" data-id=\"0a22211\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-image\">\n\t\t\t\t\t\t\t\t\t\t\t\t<img width=\"683\" height=\"1000\" src=\"https:\/\/elajmedicalcentre.ae\/ar\/wp-content\/uploads\/2018\/11\/figure2.png\" class=\"attachment-full size-full wp-image-714\" alt=\"\" loading=\"lazy\" srcset=\"https:\/\/elajmedicalcentre.ae\/ar\/wp-content\/uploads\/2018\/11\/figure2.png 683w, https:\/\/elajmedicalcentre.ae\/ar\/wp-content\/uploads\/2018\/11\/figure2-205x300.png 205w\" sizes=\"(max-width: 683px) 100vw, 683px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/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\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-5c231c67 elementor-section-stretched elementor-section-full_width elementor-section-content-middle elementor-section-height-default elementor-section-height-default\" data-id=\"5c231c67\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&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\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-538ad58d\" data-id=\"538ad58d\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7ceaf2dd elementor-widget elementor-widget-rt-cta\" data-id=\"7ceaf2dd\" data-element_type=\"widget\" data-widget_type=\"rt-cta.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"call-to-action-wrap-layout4\">\n    <div class=\"item-img\">\n           <\/div>\n    <div class=\"container\">\n        <div class=\"row\">\n            <div class=\"col-xl-12 col-lg-8 col-md-8 col-12\">\n                <div class=\"call-to-action-box-layout4\">\n                    <h2 class=\"item-title\">\u0646\u062d\u0646 \u0646\u0642\u062f\u0645 \u0623\u0639\u0644\u0649 \u0645\u0633\u062a\u0648\u0649 \u0645\u0646 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0648\u0627\u0644\u062e\u062f\u0645\u0627\u062a \u0644\u0645\u0631\u0627\u062c\u0639\u064a\u0646\u0627 <\/h2>\n                    <div class=\"call-to-action-phone\">\n                        <a href=\"tel:+12344092888\"><i class=\"fas fa-phone\"><\/i>+971 6 741 8880<\/a>\n                    <\/div>\n\t\t\t\t\t\t                 \n                <\/div>\n            <\/div>\n        <\/div>\n    <\/div>\n<\/div>\t\t<\/div>\n\t\t\t\t<\/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\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>\u0625\u062d\u062c\u0632 \u0645\u0648\u0639\u062f \u0646\u062d\u0646 \u0646\u0642\u062f\u0645 \u0623\u0639\u0644\u0649 \u0645\u0633\u062a\u0648\u0649 \u0645\u0646 \u0627\u0644\u0631\u0639\u0627\u064a\u0629 \u0648\u0627\u0644\u062e\u062f\u0645\u0627\u062a \u0644\u0645\u0631\u0627\u062c\u0639\u064a\u0646\u0627 +971 6 741 8880<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/elajmedicalcentre.ae\/ar\/wp-json\/wp\/v2\/pages\/686"}],"collection":[{"href":"https:\/\/elajmedicalcentre.ae\/ar\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/elajmedicalcentre.ae\/ar\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/elajmedicalcentre.ae\/ar\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/elajmedicalcentre.ae\/ar\/wp-json\/wp\/v2\/comments?post=686"}],"version-history":[{"count":0,"href":"https:\/\/elajmedicalcentre.ae\/ar\/wp-json\/wp\/v2\/pages\/686\/revisions"}],"wp:attachment":[{"href":"https:\/\/elajmedicalcentre.ae\/ar\/wp-json\/wp\/v2\/media?parent=686"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}