{"id":2046,"date":"2020-10-19T13:08:49","date_gmt":"2020-10-19T11:08:49","guid":{"rendered":"https:\/\/www.clinicarinologica.com\/?page_id=2046"},"modified":"2021-12-29T18:52:06","modified_gmt":"2021-12-29T16:52:06","slug":"sollicitud-de-visita","status":"publish","type":"page","link":"https:\/\/www.clinicarinologica.com\/es\/sollicitud-de-visita\/","title":{"rendered":"Solicitud de visita"},"content":{"rendered":"[vc_row el_class=\u00bbnormal_paddings_2&#8243; css=\u00bb.vc_custom_1593782624497{margin-top: 150px !important;}\u00bb][vc_column width=\u00bb1\/4&#8243;][vc_column_text el_class=\u00bbinside_title\u00bb]\r\n<h1>\u00a1Solicite ahora una visita!<\/h1>\r\n[\/vc_column_text][\/vc_column][vc_column width=\u00bb3\/4&#8243;][vc_column_text el_class=\u00bbmedium_text\u00bb]\r\n<p class=\"p1\">Rellene y env\u00ede el siguiente formulario.<\/p>\r\n[\/vc_column_text][vc_column_text]\r\n<p class=\"p3\">En la Cl\u00ednica Rinol\u00f3gica Maria Colom\u00e9 velamos por su salud nasal. En el primer contacto le escucharemos en detalle para entender cu\u00e1l es su problema -est\u00e9tico o funcional- y le explicaremos c\u00f3mo le podemos ayudar. Rellene el siguiente formulario y contactaremos con usted para concretar el primer contacto, de acuerdo con sus necesidades.<\/p>\r\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row el_class=\u00bbnormal_paddings_2&#8243; el_id=\u00bbvisita\u00bb css=\u00bb.vc_custom_1593782971059{padding-bottom: 100px !important;background-color: #282828 !important;}\u00bb][vc_column width=\u00bb1\/4&#8243;][\/vc_column][vc_column width=\u00bb1\/2&#8243;]\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2216-o1\" lang=\"ca\" dir=\"ltr\" data-wpcf7-id=\"2216\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/es\/wp-json\/wp\/v2\/pages\/2046#wpcf7-f2216-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=\"2216\" \/><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-f2216-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p>\u00bfEs su primera visita?\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=\"S\u00ed\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">S\u00ed<\/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>\u00bfCu\u00e1l es la raz\u00f3n de su consulta?\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=\"Me gustar\u00eda retocar mi nariz\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Me gustar\u00eda retocar mi nariz<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Ronco mucho y\/o tengo apneas\" \/><span class=\"wpcf7-list-item-label\">Ronco mucho y\/o tengo apneas<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"No respiro bien\" \/><span class=\"wpcf7-list-item-label\">No respiro bien<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Sufro de rinitis y\/o sinusitis\" \/><span class=\"wpcf7-list-item-label\">Sufro de rinitis y\/o sinusitis<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Tengo p\u00f3lipos\" \/><span class=\"wpcf7-list-item-label\">Tengo p\u00f3lipos<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"He perdido el olfato\" \/><span class=\"wpcf7-list-item-label\">He perdido el olfato<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Alteraciones de la voz\" \/><span class=\"wpcf7-list-item-label\">Alteraciones de la voz<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Alteraciones del o\u00eddo\" \/><span class=\"wpcf7-list-item-label\">Alteraciones del o\u00eddo<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"ORL pedi\u00e1trica\" \/><span class=\"wpcf7-list-item-label\">ORL pedi\u00e1trica<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"rao-visita\" value=\"Quiero participar en un taller\" \/><span class=\"wpcf7-list-item-label\">Quiero participar en un taller<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"rao-visita\" value=\"Otros\" \/><span class=\"wpcf7-list-item-label\">Otros<\/span><\/span><\/span><\/span>\n<\/p>\n<p>\u00bfNos quiere explicar brevemente cu\u00e1l es la raz\u00f3n de la visita?\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>Nombre\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>Apellidos\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>Edad\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>En caso de que el paciente sea menor de edad indique el nombre del padre, madre o tutor legal:\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>DNI (con letra)\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>Tel\u00e9fono\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>Correo electr\u00f3nico\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>\u00bfEn qu\u00e9 consulta quiere visitarse?\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=\"Consulta online\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Consulta online<\/span><\/span><span class=\"wpcf7-list-item\"><input type=\"radio\" name=\"lloc-consulta\" value=\"Sede Central - Salvatierra\" \/><span class=\"wpcf7-list-item-label\">Sede Central - Salvatierra<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"lloc-consulta\" value=\"Sede Teknon\" \/><span class=\"wpcf7-list-item-label\">Sede Teknon<\/span><\/span><\/span><\/span>\n<\/p>\n<p> \u00bfC\u00f3mo quiere que contactemos con usted?\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=\"Por tel\u00e9fono\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Por tel\u00e9fono<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-cont\" value=\"Por correo electr\u00f3nico\" \/><span class=\"wpcf7-list-item-label\">Por correo electr\u00f3nico<\/span><\/span><\/span><\/span>\n<\/p>\n<p> \u00bfCu\u00e1ndo prefiere realizar la visita?\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=\"Por la ma\u00f1ana\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Por la ma\u00f1ana<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-hora\" value=\"Por la tarde\" \/><span class=\"wpcf7-list-item-label\">Por la tarde<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Es usted paciente:<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=\"Privado\" checked=\"checked\" \/><span class=\"wpcf7-list-item-label\">Privado<\/span><\/span><span class=\"wpcf7-list-item last\"><input type=\"radio\" name=\"radio-tipus\" value=\"Con mutua\" \/><span class=\"wpcf7-list-item-label\">Con mutua<\/span><\/span><\/span><\/span>\n<\/p>\n<p>Elija su mutua:\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=\"Sin m\u00fatua\">Sin m\u00fatua<\/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> Los datos facilitados se utilizar\u00e1n exclusivamente para contactar con usted, hacerle llegar informaci\u00f3n para realizar la primera consulta, y ofrecerle el acceso al Espacio del Paciente.<\/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> He le\u00eddo y acepto la <a href=\"https:\/\/www.clinicarinologica.com\/es\/politica-de-privacitat\/\" target=\"_blank\">pol\u00edtica de privacidad<\/a>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Enviar\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n[\/vc_column][vc_column width=\u00bb1\/4&#8243;][\/vc_column][\/vc_row]","protected":false},"excerpt":{"rendered":"[vc_row el_class=\u00bbnormal_paddings_2&#8243; css=\u00bb.vc_custom_1593782624497{margin-top: 150px !important;}\u00bb][vc_column width=\u00bb1\/4&#8243;][vc_column_text el_class=\u00bbinside_title\u00bb] \u00a1Solicite ahora una visita! [\/vc_column_text][\/vc_column][vc_column width=\u00bb3\/4&#8243;][vc_column_text el_class=\u00bbmedium_text\u00bb] Rellene y env\u00ede el siguiente formulario. [\/vc_column_text][vc_column_text] En la Cl\u00ednica Rinol\u00f3gica Maria Colom\u00e9 velamos por su salud nasal. En el primer contacto le escucharemos en detalle para entender cu\u00e1l es su problema -est\u00e9tico o funcional- y le explicaremos c\u00f3mo le podemos&#8230; <a class=\"view-article\" href=\"https:\/\/www.clinicarinologica.com\/es\/sollicitud-de-visita\/\">Ver art\u00edculo<\/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-2046","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/pages\/2046","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/comments?post=2046"}],"version-history":[{"count":12,"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/pages\/2046\/revisions"}],"predecessor-version":[{"id":4112,"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/pages\/2046\/revisions\/4112"}],"wp:attachment":[{"href":"https:\/\/www.clinicarinologica.com\/es\/wp-json\/wp\/v2\/media?parent=2046"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}