{"id":3239,"date":"2021-01-27T19:16:20","date_gmt":"2021-01-27T17:16:20","guid":{"rendered":"https:\/\/www.clinicarinologica.com\/?page_id=3239"},"modified":"2021-12-29T18:52:37","modified_gmt":"2021-12-29T16:52:37","slug":"solicitud-visita","status":"publish","type":"page","link":"https:\/\/www.clinicarinologica.com\/en\/solicitud-visita\/","title":{"rendered":"Request an appointment"},"content":{"rendered":"[vc_row el_class=&#8221;normal_paddings_2&#8243; css=&#8221;.vc_custom_1593782624497{margin-top: 150px !important;}&#8221;][vc_column width=&#8221;1\/4&#8243;][vc_column_text el_class=&#8221;inside_title&#8221;]\r\n<h1>Request an appointment<\/h1>\r\n[\/vc_column_text][\/vc_column][vc_column width=&#8221;3\/4&#8243;][vc_column_text el_class=&#8221;medium_text&#8221;]\r\n<p class=\"p1\">Fill in and send the following form.<\/p>\r\n[\/vc_column_text][vc_column_text]\r\n<p class=\"p3\">At the Cl\u00ednica Rinol\u00f2gica Maria Colom\u00e9 we take care of your nasal health. In the first visit we will listen to you in detail to understand what your problem is &#8211; aesthetic or functional &#8211; and we will explain how we can help you. Fill in the following form and we will contact you to make the first contact, according to your needs.<\/p>\r\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row el_class=&#8221;normal_paddings_2&#8243; el_id=&#8221;visita&#8221; css=&#8221;.vc_custom_1593782971059{padding-bottom: 100px !important;background-color: #282828 !important;}&#8221;][vc_column width=&#8221;1\/4&#8243;][\/vc_column][vc_column width=&#8221;1\/2&#8243;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f3515-o1\" lang=\"ca\" dir=\"ltr\" data-wpcf7-id=\"3515\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/en\/wp-json\/wp\/v2\/pages\/3239#wpcf7-f3515-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Formulari de contacte\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"3515\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"ca\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f3515-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p>Is this your first visit?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"primera\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"primera\" value=\"Yes\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"primera\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p>What is the reason for your inquiry?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"rao-visita\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"rao-visita\" value=\"I would like to touch up my nose\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">I would like to touch up my nose<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"I snore a lot and \/ or I have apneas\" \/><span class=\"wpcf7-list-item-label\">I snore a lot and \/ or I have apneas<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"I do not breathe well\" \/><span class=\"wpcf7-list-item-label\">I do not breathe well<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"I suffer from rhinitis and \/ or sinusitis\" \/><span class=\"wpcf7-list-item-label\">I suffer from rhinitis and \/ or sinusitis<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"I have polyps\" \/><span class=\"wpcf7-list-item-label\">I have polyps<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"I have lost my sense of smell\" \/><span class=\"wpcf7-list-item-label\">I have lost my sense of smell<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Voice disorders\" \/><span class=\"wpcf7-list-item-label\">Voice disorders<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Hearing disorders\" \/><span class=\"wpcf7-list-item-label\">Hearing disorders<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Pediatric\" \/><span class=\"wpcf7-list-item-label\">Pediatric<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"I want to participate in a workshop\" \/><span class=\"wpcf7-list-item-label\">I want to participate in a workshop<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"rao-visita\" value=\"Others\" \/><span class=\"wpcf7-list-item-label\">Others<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Would you like to briefly explain the reason for the visit?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"explicacio\"><textarea cols=\"40\" rows=\"10\" maxlength=\"2000\" class=\"wpcf7-form-control wpcf7-textarea\" aria-invalid=\"false\" name=\"explicacio\"><\/textarea><\/span>\n<\/p>\n<p>Name\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span>\n<\/p>\n<p>Surname\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-cognom\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-cognom\" \/><\/span>\n<\/p>\n<p>Age\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-edat\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-edat\" \/><\/span>\n<\/p>\n<p>In case the patient is a child, indicate the name of the father, mother or legal guardian:\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-tutor\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-tutor\" \/><\/span>\n<\/p>\n<p>ID\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-dni\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-dni\" \/><\/span>\n<\/p>\n<p>Telephone\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-telefon\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-telefon\" \/><\/span>\n<\/p>\n<p>e-mail\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"your-correu\"><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\" value=\"\" type=\"email\" name=\"your-correu\" \/><\/span>\n<\/p>\n<p>In which clinic do you want to visit?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"lloc-consulta\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"lloc-consulta\" value=\"online\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">online<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"lloc-consulta\" value=\"Headquarters - Salvatierra\" \/><span class=\"wpcf7-list-item-label\">Headquarters - Salvatierra<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"lloc-consulta\" value=\"Teknon Clinic\" \/><span class=\"wpcf7-list-item-label\">Teknon Clinic<\/span><\/span><\/span><\/span>\n<\/p>\n<p>How do you want us to contact you?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-cont\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-cont\" value=\"By phone\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">By phone<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-cont\" value=\"By email\" \/><span class=\"wpcf7-list-item-label\">By email<\/span><\/span><\/span><\/span>\n<\/p>\n<p>When do you prefer to visit?\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"radio-hora\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-hora\" value=\"In the morning\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">In the morning<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-hora\" value=\"In the afternoon\" \/><span class=\"wpcf7-list-item-label\">In the afternoon<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Are you a patient:<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"radio-tipus\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><input type=\"radio\" name=\"radio-tipus\" value=\"Private\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Private<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-tipus\" value=\"With insurance\" \/><span class=\"wpcf7-list-item-label\">With insurance<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Choose your insurance:\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"mutua-sel\"><select class=\"wpcf7-form-control wpcf7-select\" aria-invalid=\"false\" name=\"mutua-sel\"><option value=\"No insurance\">No insurance<\/option><option value=\"Aegon Espa\u00f1a\">Aegon Espa\u00f1a<\/option><option value=\"Agrupaci\u00f3 m\u00fatua\">Agrupaci\u00f3 m\u00fatua<\/option><option value=\"Allianz\">Allianz<\/option><option value=\"Assist\u00e8ncia Sanit\u00e0ria Col\u00b7legial\">Assist\u00e8ncia Sanit\u00e0ria Col\u00b7legial<\/option><option value=\"ASSSA\">ASSSA<\/option><option value=\"Axa\">Axa<\/option><option value=\"Caser\">Caser<\/option><option value=\"Dkv (Previasa)\">Dkv (Previasa)<\/option><option value=\"Generali\">Generali<\/option><option value=\"HNA SC\">HNA SC<\/option><option value=\"Medifiatc\">Medifiatc<\/option><option value=\"MEPS\">MEPS<\/option><option value=\"M\u00fatua General de Catalunya\">M\u00fatua General de Catalunya<\/option><option value=\"M\u00fatua Previsora de Barcelona (Fonsalut)\">M\u00fatua Previsora de Barcelona (Fonsalut)<\/option><option value=\"Plus Ultra\">Plus Ultra<\/option><option value=\"Qualimedic\">Qualimedic<\/option><option value=\"Sanitas\">Sanitas<\/option><option value=\"Sersanet\">Sersanet<\/option><option value=\"Vital Seguro\">Vital Seguro<\/option><option value=\"Atl\u00e0ntida\">Atl\u00e0ntida<\/option><option value=\"Cosalud\">Cosalud<\/option><option value=\"SharedCare\">SharedCare<\/option><\/select><\/span>\n<\/p>\n<p><em> The data provided will be used exclusively to contact you, send you information to make the first consultation, and offer you access to the Patient Area.<\/em>\n<\/p>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"acceptance-905\"><span class=\"wpcf7-form-control wpcf7-acceptance\"><span class=\"wpcf7-list-item\"><input type=\"checkbox\" name=\"acceptance-905\" value=\"1\" aria-invalid=\"false\" \/><\/span><\/span><\/span> I've read and accepted the <a href=\"https:\/\/www.clinicarinologica.com\/es\/politica-de-privacitat\/\" target=\"_blank\">privacy policy<\/a>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][vc_column width=&#8221;1\/4&#8243;][\/vc_column][\/vc_row]","protected":false},"excerpt":{"rendered":"[vc_row el_class=&#8221;normal_paddings_2&#8243; css=&#8221;.vc_custom_1593782624497{margin-top: 150px !important;}&#8221;][vc_column width=&#8221;1\/4&#8243;][vc_column_text el_class=&#8221;inside_title&#8221;] Request an appointment [\/vc_column_text][\/vc_column][vc_column width=&#8221;3\/4&#8243;][vc_column_text el_class=&#8221;medium_text&#8221;] Fill in and send the following form. [\/vc_column_text][vc_column_text] At the Cl\u00ednica Rinol\u00f2gica Maria Colom\u00e9 we take care of your nasal health. In the first visit we will listen to you in detail to understand what your problem is &#8211; aesthetic or functional&#8230; <a class=\"view-article\" href=\"https:\/\/www.clinicarinologica.com\/en\/solicitud-visita\/\">View Article<\/a>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-3239","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.clinicarinologica.com\/en\/wp-json\/wp\/v2\/pages\/3239","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.clinicarinologica.com\/en\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.clinicarinologica.com\/en\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.clinicarinologica.com\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.clinicarinologica.com\/en\/wp-json\/wp\/v2\/comments?post=3239"}],"version-history":[{"count":7,"href":"https:\/\/www.clinicarinologica.com\/en\/wp-json\/wp\/v2\/pages\/3239\/revisions"}],"predecessor-version":[{"id":4114,"href":"https:\/\/www.clinicarinologica.com\/en\/wp-json\/wp\/v2\/pages\/3239\/revisions\/4114"}],"wp:attachment":[{"href":"https:\/\/www.clinicarinologica.com\/en\/wp-json\/wp\/v2\/media?parent=3239"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}