{"id":553,"date":"2016-02-17T09:13:12","date_gmt":"2016-02-17T09:13:12","guid":{"rendered":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter\/?page_id=553"},"modified":"2016-03-21T11:32:46","modified_gmt":"2016-03-21T11:32:46","slug":"appointment-request","status":"publish","type":"page","link":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/appointment-request\/","title":{"rendered":"Appointment Request"},"content":{"rendered":"<p>We would love to hear from you! Please call us for a chat or fill in the following form to request an appointment, and we will get right back to you!<\/p>\n<div class=\"row appointment-imgs color-box\">\n<div class=\"col-sm-4\">\n<img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"300\" src=\"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-content\/uploads\/sites\/197\/2016\/02\/appointment-img1.jpg\" alt=\"Southside Children&#039;s Dental Center\" class=\"aligncenter size-full wp-image-926\" srcset=\"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-content\/uploads\/sites\/197\/2016\/02\/appointment-img1.jpg 400w, http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-content\/uploads\/sites\/197\/2016\/02\/appointment-img1-300x225.jpg 300w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/>\n<\/div>\n<div class=\"col-sm-4 page-hours\">\n<h2>Opening Hours: <\/h2>\n<p><strong>Monday \u2013 Friday<\/strong><\/p>\n<p><strong>Pediatric Dentist<\/strong><br \/>\n7:00 AM \u2013 5:00 PM<\/p>\n<p><strong>Orthodontist<\/strong><br \/>\n8:30 AM \u2013 5:00 PM\n<\/p>\n<\/div>\n<div class=\"col-sm-4\">\n<img loading=\"lazy\" decoding=\"async\" width=\"400\" height=\"300\" src=\"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-content\/uploads\/sites\/197\/2016\/02\/appointment-img2.jpg\" alt=\"Southside Children&#039;s Dental Center\" class=\"aligncenter size-full wp-image-927\" srcset=\"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-content\/uploads\/sites\/197\/2016\/02\/appointment-img2.jpg 400w, http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-content\/uploads\/sites\/197\/2016\/02\/appointment-img2-300x225.jpg 300w\" sizes=\"(max-width: 400px) 100vw, 400px\" \/>\n<\/div>\n<\/div>\n<h2>Appointment Request Form<\/h2>\n<div class=\"page-form appointment\">\n<p>Please fill out all of the following.<br \/>\nWe strive to treat our patients in an efficient and time conscience manner. However, depending on the nature of your appointment it may not be possible to accommodate the date and\/or time you have requested. We will contact you to confirm your appointment details.<\/p>\n<div role=\"form\" class=\"wpcf7\" id=\"wpcf7-f815-o1\" lang=\"en-US\" dir=\"ltr\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/pages\/553#wpcf7-f815-o1\" method=\"post\" class=\"wpcf7-form init\" novalidate=\"novalidate\" data-status=\"init\">\n<div style=\"display: none;\">\n<input type=\"hidden\" name=\"_wpcf7\" value=\"815\" \/>\n<input type=\"hidden\" name=\"_wpcf7_version\" value=\"5.5.6.1\" \/>\n<input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/>\n<input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f815-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=\"contact_custom animate fadeInLeftLarge\" data-anim-delay=\"600\" data-anim-type=\"fadeInLeftLarge\">\n<label><strong>Reason For Visit<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap menu-876\"><select name=\"menu-876\" class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\"><option value=\"Pediatric Visit\">Pediatric Visit<\/option><option value=\"Orthodontics\">Orthodontics<\/option><\/select><\/span><\/p>\n<div class=\"grup\">\n<label><strong>Patient Name*<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap fullName\"><input type=\"text\" name=\"fullName\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-371\"><input type=\"text\" name=\"text-371\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last\" \/><\/span>\n<\/div>\n<div class=\"grup\">\n<label><strong>Parent\/Guardian Name*<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap text-638\"><input type=\"text\" name=\"text-638\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"First\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-299\"><input type=\"text\" name=\"text-299\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Last\" \/><\/span>\n<\/div>\n<p><label><strong>Parent\/Guardian Phone Number*<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap validPhone\"><input type=\"tel\" name=\"validPhone\" value=\"\" size=\"40\" maxlength=\"17\" minlength=\"10\" class=\"wpcf7-form-control wpcf7-text wpcf7-tel wpcf7-validates-as-required wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/p>\n<p><label><strong>Parent\/Guardian Address*<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap text-27\"><input type=\"text\" name=\"text-27\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Street Address\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-177\"><input type=\"text\" name=\"text-177\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Street Address2\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-401\"><input type=\"text\" name=\"text-401\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"City\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-182\"><input type=\"text\" name=\"text-182\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"State \/ Province \/ Region\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-292\"><input type=\"text\" name=\"text-292\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Postal \/ Zip Code\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-428\"><input type=\"text\" name=\"text-428\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"Country\" \/><\/span><\/p>\n<p><label><strong>Parent\/Guardian Email Address*<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap emailAddress\"><input type=\"email\" name=\"emailAddress\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text wpcf7-email wpcf7-validates-as-required wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" \/><\/span><\/p>\n<p><label><strong>Requested Appointment Date:<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap date-454\"><input type=\"text\" name=\"date-454\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required\" aria-required=\"true\" placeholder=\"mm\/dd\/yyyy\" \/> <\/span><\/p>\n<p><label><strong>Requested Appointment Time:<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap datetime-723\"><input type=\"text\" name=\"datetime-723\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-date wpcf7-datetime wpcf7-validates-as-required\" aria-required=\"true\" placeholder=\"HH:MM\" \/> <\/span><\/p>\n<p class=\"radio-btn\"><span class=\"wpcf7-form-control-wrap radio-948\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first last\"><input type=\"radio\" name=\"radio-948\" value=\"Speak Spanish\" \/><span class=\"wpcf7-list-item-label\">Speak Spanish<\/span><\/span><\/span><\/span><\/p>\n<p><label><strong>Additional Information:<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap Message\"><textarea name=\"Message\" cols=\"40\" rows=\"10\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\"><\/textarea><\/span><\/p>\n<p><strong>If you are scheduling for more than one patient, please add their names here.<\/strong><\/p>\n<div class=\"grup\">\n<label><strong>Patient Name<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap text-343\"><input type=\"text\" name=\"text-343\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"First\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-897\"><input type=\"text\" name=\"text-897\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Last\" \/><\/span>\n<\/div>\n<div class=\"grup\">\n<label><strong>Patient Name<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap text-443\"><input type=\"text\" name=\"text-443\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"First\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-613\"><input type=\"text\" name=\"text-613\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Last\" \/><\/span>\n<\/div>\n<div class=\"grup\">\n<label><strong>Patient Name<\/strong><\/label><br \/>\n<span class=\"wpcf7-form-control-wrap text-760\"><input type=\"text\" name=\"text-760\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"First\" \/><\/span><br \/>\n<span class=\"wpcf7-form-control-wrap text-932\"><input type=\"text\" name=\"text-932\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" placeholder=\"Last\" \/><\/span>\n<\/div>\n<div class=\"captcha-number\"><label class=\"captcha-img\"><input type=\"hidden\" name=\"_wpcf7_captcha_challenge_captcha-44\" value=\"4068388221\" \/><img loading=\"lazy\" decoding=\"async\" class=\"wpcf7-form-control wpcf7-captchac wpcf7-captcha-captcha-44\" width=\"72\" height=\"24\" alt=\"captcha\" src=\"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-content\/uploads\/sites\/197\/wpcf7_captcha\/4068388221.png\" \/> <\/label><span class=\"captcha-txt\"><span class=\"wpcf7-form-control-wrap captcha-44\"><input type=\"text\" name=\"captcha-44\" value=\"\" size=\"40\" class=\"wpcf7-form-control wpcf7-captchar\" autocomplete=\"off\" aria-invalid=\"false\" placeholder=\"Enter The Code Shown*\" \/><\/span><\/span><\/div>\n<div class=\"cf7_submit\"><input type=\"submit\" value=\"Submit\" class=\"wpcf7-form-control has-spinner wpcf7-submit\" \/><\/div>\n<div class=\"field\">(<span class=\"star\">*<\/span>) Fields are Mandatory<\/div>\n<\/div>\n<div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div><\/form><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>We would love to hear from you! Please call us for a chat or fill in the following form to request an appointment, and we will get right back to you! Opening Hours: Monday \u2013 Friday Pediatric Dentist 7:00 AM \u2013 5:00 PM Orthodontist 8:30 AM \u2013 5:00 PM Appointment Request Form Please fill out&#8230;  <a href=\"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/appointment-request\/\" class=\"more-link\" title=\"Read Appointment Request\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"_links":{"self":[{"href":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/pages\/553"}],"collection":[{"href":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/comments?post=553"}],"version-history":[{"count":5,"href":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/pages\/553\/revisions"}],"predecessor-version":[{"id":1390,"href":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/pages\/553\/revisions\/1390"}],"wp:attachment":[{"href":"http:\/\/coxmedia.thestagingurl.com\/southsidechildrensdentalcenter1\/wp-json\/wp\/v2\/media?parent=553"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}