{"id":880,"date":"2022-10-29T06:20:05","date_gmt":"2022-10-29T06:20:05","guid":{"rendered":"https:\/\/shatayuhospital.in\/?page_id=880"},"modified":"2023-01-24T06:51:04","modified_gmt":"2023-01-24T06:51:04","slug":"consultation","status":"publish","type":"page","link":"https:\/\/shatayuhospital.in\/index.php\/consultation\/","title":{"rendered":"Consultation"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"880\" class=\"elementor elementor-880\" data-elementor-settings=\"[]\">\n\t\t\t\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-658b165 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"658b165\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-3c77cf7\" data-id=\"3c77cf7\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7560300 elementor-widget elementor-widget-heading\" data-id=\"7560300\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Medical Consultation Form<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\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-4eab955 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"4eab955\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-ffac0f4\" data-id=\"ffac0f4\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-element elementor-element-31c9db0 elementor-widget elementor-widget-wp-widget-wpforms-widget\" data-id=\"31c9db0\" data-element_type=\"widget\" data-widget_type=\"wp-widget-wpforms-widget.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-902\"><form id=\"wpforms-form-902\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"902\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/880\" data-token=\"78fde86221817f4b1b927153ac2f18ca\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-field-container\"><div id=\"wpforms-902-field_2-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_2\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-902-field_2\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][2][first]\" placeholder=\"Name\" required><label for=\"wpforms-902-field_2\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-902-field_2-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][2][last]\" placeholder=\"Surname\" required><label for=\"wpforms-902-field_2-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/div><div id=\"wpforms-902-field_3-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_3\">Phone Number<\/label><input type=\"number\" pattern=\"\\d*\" id=\"wpforms-902-field_3\" class=\"wpforms-field-medium\" name=\"wpforms[fields][3]\" placeholder=\"xxxxxxxxxx\" ><\/div><div id=\"wpforms-902-field_4-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_4\">Email <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"email\" id=\"wpforms-902-field_4\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][4]\" placeholder=\"email@mail.com\" required><\/div><div id=\"wpforms-902-field_15-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_15\">Address<\/label><input type=\"text\" id=\"wpforms-902-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" ><\/div><div id=\"wpforms-902-field_14-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_14\">Age of the Patient<\/label><input\n\ttype=\"range\"\n\tid=\"wpforms-902-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" value=\"0\"\t\tvalue=\"0\"\n\tmin=\"0\"\n\tmax=\"100\"\n\tstep=\"1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Selected Value: {value}\">\n\tSelected Value: <b>0<\/b><\/div>\n<\/div><div id=\"wpforms-902-field_5-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_5\">Gender<\/label><ul id=\"wpforms-902-field_5\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_5_1\" name=\"wpforms[fields][5]\" value=\"Male\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_5_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_5_2\" name=\"wpforms[fields][5]\" value=\"Female\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_5_2\">Female<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_5_3\" name=\"wpforms[fields][5]\" value=\"Transgender\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_5_3\">Transgender<\/label><\/li><\/ul><\/div><div id=\"wpforms-902-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_6\">Date Of Birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-902-field_6\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][6]\" placeholder=\"YYYY\/MM\/DD\" required><\/div><div id=\"wpforms-902-field_27-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_27\">HEIGHT<\/label><input\n\ttype=\"range\"\n\tid=\"wpforms-902-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" value=\"0\"\t\tvalue=\"0\"\n\tmin=\"0\"\n\tmax=\"10\"\n\tstep=\"0.1\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Selected Value: {value}\">\n\tSelected Value: <b>0<\/b><\/div>\n<\/div><div id=\"wpforms-902-field_28-container\" class=\"wpforms-field wpforms-field-number-slider\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_28\">WEIGHT<\/label><input\n\ttype=\"range\"\n\tid=\"wpforms-902-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" value=\"0\"\t\tvalue=\"0\"\n\tmin=\"0\"\n\tmax=\"200\"\n\tstep=\"0.5\">\n\n<div class=\"wpforms-field-number-slider-hint\"\n\tdata-hint=\"Selected Value: {value}\">\n\tSelected Value: <b>0<\/b><\/div>\n<\/div><div id=\"wpforms-902-field_16-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"16\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_16\">Education<\/label><input type=\"text\" id=\"wpforms-902-field_16\" class=\"wpforms-field-medium\" name=\"wpforms[fields][16]\" ><\/div><div id=\"wpforms-902-field_17-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"17\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_17\">Occupation<\/label><input type=\"text\" id=\"wpforms-902-field_17\" class=\"wpforms-field-medium\" name=\"wpforms[fields][17]\" ><\/div><div id=\"wpforms-902-field_24-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_24\">Have you seen a doctor for any of the following illnesses ? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-902-field_24\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_24_1\" name=\"wpforms[fields][24][]\" value=\"High blood pressure\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_24_1\">High blood pressure<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_24_2\" name=\"wpforms[fields][24][]\" value=\"Heart Disease\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_24_2\">Heart Disease<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_24_3\" name=\"wpforms[fields][24][]\" value=\"High Cholesterol\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_24_3\">High Cholesterol<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_24_4\" name=\"wpforms[fields][24][]\" value=\"Diabetes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_24_4\">Diabetes<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_24_5\" name=\"wpforms[fields][24][]\" value=\"None\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_24_5\">None<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_24_6\" name=\"wpforms[fields][24][]\" value=\"Others\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_24_6\">Others<\/label><\/li><\/ul><\/div><div id=\"wpforms-902-field_25-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_25\">Any Allergies?<\/label><textarea id=\"wpforms-902-field_25\" class=\"wpforms-field-medium\" name=\"wpforms[fields][25]\" ><\/textarea><\/div><div id=\"wpforms-902-field_12-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_12\">Specify Reason For Consultation in Detail <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-902-field_12\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][12]\" required><\/div><div id=\"wpforms-902-field_19-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"19\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_19\">History of any previous illness<\/label><textarea id=\"wpforms-902-field_19\" class=\"wpforms-field-medium\" name=\"wpforms[fields][19]\" ><\/textarea><\/div><div id=\"wpforms-902-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_20\">Family history<\/label><ul id=\"wpforms-902-field_20\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_1\" name=\"wpforms[fields][20][]\" value=\"HYPERTENSION\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_1\">HYPERTENSION<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_2\" name=\"wpforms[fields][20][]\" value=\"HEART PROBLEMS\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_2\">HEART PROBLEMS<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_3\" name=\"wpforms[fields][20][]\" value=\"ASTHMA\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_3\">ASTHMA<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_4\" name=\"wpforms[fields][20][]\" value=\"ARTHRITIS\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_4\">ARTHRITIS<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_5\" name=\"wpforms[fields][20][]\" value=\"SKIN PROBLEMS\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_5\">SKIN PROBLEMS<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_6\" name=\"wpforms[fields][20][]\" value=\"PARALYSIS\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_6\">PARALYSIS<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_7\" name=\"wpforms[fields][20][]\" value=\"DIABETES\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_7\">DIABETES<\/label><\/li><li class=\"choice-9 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_9\" name=\"wpforms[fields][20][]\" value=\"PCOD\/PCOS\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_9\">PCOD\/PCOS<\/label><\/li><li class=\"choice-10 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_10\" name=\"wpforms[fields][20][]\" value=\"THYROID\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_10\">THYROID<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"checkbox\" id=\"wpforms-902-field_20_8\" name=\"wpforms[fields][20][]\" value=\"NONE\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_20_8\">NONE<\/label><\/li><\/ul><\/div><div id=\"wpforms-902-field_22-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_22\">Any Accidental or fall History  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-902-field_22\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_22_1\" name=\"wpforms[fields][22]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_22_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_22_2\" name=\"wpforms[fields][22]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_22_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-902-field_13-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_13\">Have you ever undergone surgery? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-902-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_13_1\" name=\"wpforms[fields][13]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_13_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_13_2\" name=\"wpforms[fields][13]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_13_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-902-field_26-container\" class=\"wpforms-field wpforms-field-radio\" data-field-id=\"26\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_26\">Are you currently on any medicines? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-902-field_26\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_26_1\" name=\"wpforms[fields][26]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_26_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-902-field_26_2\" name=\"wpforms[fields][26]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-902-field_26_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-902-field_23-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-902-field_23\">Any surgical history<\/label><textarea id=\"wpforms-902-field_23\" class=\"wpforms-field-medium\" name=\"wpforms[fields][23]\" ><\/textarea><\/div><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"902\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" class=\"wpforms-submit \" id=\"wpforms-submit-902\" value=\"wpforms-submit\" aria-live=\"assertive\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\">Submit<\/button><img loading=\"lazy\" src=\"https:\/\/shatayuhospital.in\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"\"><\/div><\/form><\/div>  <!-- .wpforms-container -->\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Medical Consultation Form<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"om_disable_all_campaigns":false,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0},"_links":{"self":[{"href":"https:\/\/shatayuhospital.in\/index.php\/wp-json\/wp\/v2\/pages\/880"}],"collection":[{"href":"https:\/\/shatayuhospital.in\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/shatayuhospital.in\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/shatayuhospital.in\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/shatayuhospital.in\/index.php\/wp-json\/wp\/v2\/comments?post=880"}],"version-history":[{"count":55,"href":"https:\/\/shatayuhospital.in\/index.php\/wp-json\/wp\/v2\/pages\/880\/revisions"}],"predecessor-version":[{"id":1002,"href":"https:\/\/shatayuhospital.in\/index.php\/wp-json\/wp\/v2\/pages\/880\/revisions\/1002"}],"wp:attachment":[{"href":"https:\/\/shatayuhospital.in\/index.php\/wp-json\/wp\/v2\/media?parent=880"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}