{"id":21,"date":"2022-03-01T14:36:41","date_gmt":"2022-03-01T14:36:41","guid":{"rendered":"https:\/\/octrom.org\/docs\/?page_id=21"},"modified":"2022-04-05T17:54:12","modified_gmt":"2022-04-05T17:54:12","slug":"contact-us","status":"publish","type":"page","link":"https:\/\/octrom.org\/docs\/contact-us\/","title":{"rendered":"Contact Us"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_1_container\" data-token=\"85af8f3568cb0abb5049d408005b12c8\">\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_contact-form\" data-token=\"85af8f3568cb0abb5049d408005b12c8\">\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">Chart request<\/legend>\r\n<h3 class=\"frm_form_title\">Chart request<\/h3>\r\n<div class=\"frm_description\"><p>Please fill out the form below to inquire about your chart, and we will get back to you shortly.<\/p>\n<hr \/>\n<\/div><div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"1\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_1\" id=\"frm_hide_fields_1\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"contact-form\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_1\" name=\"frm_submit_entry_1\" value=\"41481bcc3a\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/docs\/wp-json\/wp\/v2\/pages\/21\" \/><div id=\"frm_field_1_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_first frm_half\">\r\n    <label for=\"field_qh4icy\" id=\"field_qh4icy_label\" class=\"frm_primary_label\">Name\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_qh4icy\" name=\"item_meta[1]\" value=\"\"  maxlength=\"50\" placeholder=\"First Name\" data-reqmsg=\"Name cannot be blank.\" aria-required=\"true\" data-invmsg=\"Name is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_qh4icy\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_qh4icy\">First<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_2_container\" class=\"frm_form_field form-field  frm_required_field frm_hidden_container frm_half\">\r\n    <label for=\"field_ocfup1\" id=\"field_ocfup1_label\" class=\"frm_primary_label\">Last\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_ocfup1\" name=\"item_meta[2]\" value=\"\"  maxlength=\"30\" placeholder=\"Last Name\" data-reqmsg=\"Last cannot be blank.\" aria-required=\"true\" data-invmsg=\"Last is invalid\" aria-invalid=\"false\"   aria-describedby=\"frm_desc_field_ocfup1\"\/>\r\n    <div class=\"frm_description\" id=\"frm_desc_field_ocfup1\">Last<\/div>\r\n    \r\n<\/div>\n<div id=\"frm_field_3_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half frm6 frm_first\">\r\n    <label for=\"field_29yf4d\" id=\"field_29yf4d_label\" class=\"frm_primary_label\">Email (excluding @sympatico.ca)\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"email\" id=\"field_29yf4d\" name=\"item_meta[3]\" value=\"\"  maxlength=\"50\" data-reqmsg=\"Email (excluding @sympatico.ca) cannot be blank.\" aria-required=\"true\" data-invmsg=\"Please enter a valid email address\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_10_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm6\">\r\n    <label for=\"field_bdpf5\" id=\"field_bdpf5_label\" class=\"frm_primary_label\">Phone \r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"tel\" id=\"field_bdpf5\" name=\"item_meta[10]\" value=\"\"  maxlength=\"10\" placeholder=\"ex: 6131231234\" data-reqmsg=\"Phone  cannot be blank.\" aria-required=\"true\" data-invmsg=\"Phone is invalid\" aria-invalid=\"false\" pattern=\"\\d\\d\\d\\d\\d\\d\\d\\d\\d\\d$\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_11_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container frm_half\">\r\n    <label for=\"field_c890b\" id=\"field_c890b_label\" class=\"frm_primary_label\">Last Name of your former doctor\r\n        <span class=\"frm_required\" aria-hidden=\"true\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_c890b\" name=\"item_meta[11]\" value=\"\"  maxlength=\"15\" placeholder=\"Last Name\" data-reqmsg=\"Last Name of your former doctor cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_14_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_sufxh\" id=\"field_sufxh_label\" class=\"frm_primary_label\">Short Message (optional)\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_sufxh\" name=\"item_meta[14]\" value=\"\"  maxlength=\"250\" placeholder=\"Max 250 characters\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_7_container\" class=\"frm_form_field form-field  frm_none_container\">\r\n    <label for=\"g-recaptcha-response\" id=\"field_35mw4_label\" class=\"frm_primary_label\">reCAPTCHA\r\n        <span class=\"frm_required\" aria-hidden=\"true\"><\/span>\r\n    <\/label>\r\n    <div  id=\"field_35mw4\" class=\"g-recaptcha\" data-sitekey=\"6LfntKoeAAAAAIp3d1H9BmdWDiPjClBvoEQWUL3x\" data-size=\"invisible\" data-theme=\"light\" data-callback=\"frmAfterRecaptcha\"><\/div>\r\n    \r\n    \r\n<\/div>\n\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm__65a85064a35f1\">\n\t\t\t\t<label for=\"frm_email_1\" >\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input  id=\"frm_email_1\" type=\"text\" class=\"frm_verify\" name=\"frm__65a85064a35f1\" value=\"\" autocomplete=\"off\"  \/>\n\t\t\t<\/div>\n\t\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n\n<\/form>\n<\/div>\n\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-21","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/octrom.org\/docs\/wp-json\/wp\/v2\/pages\/21","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/octrom.org\/docs\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/octrom.org\/docs\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/octrom.org\/docs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/octrom.org\/docs\/wp-json\/wp\/v2\/comments?post=21"}],"version-history":[{"count":11,"href":"https:\/\/octrom.org\/docs\/wp-json\/wp\/v2\/pages\/21\/revisions"}],"predecessor-version":[{"id":64,"href":"https:\/\/octrom.org\/docs\/wp-json\/wp\/v2\/pages\/21\/revisions\/64"}],"wp:attachment":[{"href":"https:\/\/octrom.org\/docs\/wp-json\/wp\/v2\/media?parent=21"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}