{"id":349,"date":"2023-11-02T12:11:51","date_gmt":"2023-11-02T12:11:51","guid":{"rendered":"https:\/\/careinsignia.com\/?page_id=349"},"modified":"2023-11-04T11:55:49","modified_gmt":"2023-11-04T11:55:49","slug":"testimonial-submission","status":"publish","type":"page","link":"https:\/\/careinsignia.com\/index.php\/testimonial-submission\/","title":{"rendered":"Patient Feedback Form"},"content":{"rendered":"\n<p>Hi, <\/p>\n\n\n\n<p>We hope you are well and you have had a fruitful time with us throughout our time together. <\/p>\n\n\n\n<p>We look forward to hearing back from you. Your opinion matters, and we would appreciate if you write to us about your experience with us.<\/p>\n\n\n<style id=\"wpforms-css-vars-root\">\n\t\t\t\t:root {\n\t\t\t\t\t--wpforms-field-border-radius: 3px;\n--wpforms-field-background-color: #ffffff;\n--wpforms-field-border-color: rgba( 0, 0, 0, 0.25 );\n--wpforms-field-text-color: rgba( 0, 0, 0, 0.7 );\n--wpforms-label-color: rgba( 0, 0, 0, 0.85 );\n--wpforms-label-sublabel-color: rgba( 0, 0, 0, 0.55 );\n--wpforms-label-error-color: #d63637;\n--wpforms-button-border-radius: 3px;\n--wpforms-button-background-color: #066aab;\n--wpforms-button-text-color: #ffffff;\n--wpforms-field-size-input-height: 43px;\n--wpforms-field-size-input-spacing: 15px;\n--wpforms-field-size-font-size: 16px;\n--wpforms-field-size-line-height: 19px;\n--wpforms-field-size-padding-h: 14px;\n--wpforms-field-size-checkbox-size: 16px;\n--wpforms-field-size-sublabel-spacing: 5px;\n--wpforms-field-size-icon-size: 1;\n--wpforms-label-size-font-size: 16px;\n--wpforms-label-size-line-height: 19px;\n--wpforms-label-size-sublabel-font-size: 14px;\n--wpforms-label-size-sublabel-line-height: 17px;\n--wpforms-button-size-font-size: 17px;\n--wpforms-button-size-height: 41px;\n--wpforms-button-size-padding-h: 15px;\n--wpforms-button-size-margin-top: 10px;\n\n\t\t\t\t}\n\t\t\t<\/style><style id=\"wpforms-css-vars-152-block-3fbdd5f8-01cc-445c-94a6-fb7842a77f9b\">\n\t\t\t\t#wpforms-152.wpforms-block-3fbdd5f8-01cc-445c-94a6-fb7842a77f9b {\n\t\t\t\t\t--wpforms-button-border-radius: 1px;\n\n\t\t\t\t}\n\t\t\t<\/style><div class=\"wpforms-container wpforms-container-full wpforms-block wpforms-block-3fbdd5f8-01cc-445c-94a6-fb7842a77f9b wpforms-render-modern\" id=\"wpforms-152\"><form id=\"wpforms-form-152\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"152\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/index.php\/wp-json\/wp\/v2\/pages\/349\" data-token=\"71577cd57afe8f0a35ef26b286a792c9\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-hidden\" id=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-152-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-152-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-152-field_0-error\" required><label for=\"wpforms-152-field_0\" class=\"wpforms-field-sublabel after \">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-152-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-152-field_0-last-error\" required><label for=\"wpforms-152-field_0-last\" class=\"wpforms-field-sublabel after \">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-152-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-152-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-152-field_1\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-152-field_1-error\" required><\/div><div id=\"wpforms-152-field_7-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"7\"><fieldset><legend class=\"wpforms-field-label\">I look forward to hearing back from you. Your opinion matters, we would appreciate if you write to us of your experience with us. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-152-field_7\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_7_1\" name=\"wpforms[fields][7]\" value=\"1\" aria-errormessage=\"wpforms-152-field_7_1-error\" aria-describedby=\"wpforms-152-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_7_1\">1<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_7_2\" name=\"wpforms[fields][7]\" value=\"2\" aria-errormessage=\"wpforms-152-field_7_2-error\" aria-describedby=\"wpforms-152-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_7_2\">2<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_7_3\" name=\"wpforms[fields][7]\" value=\"3\" aria-errormessage=\"wpforms-152-field_7_3-error\" aria-describedby=\"wpforms-152-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_7_3\">3<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_7_4\" name=\"wpforms[fields][7]\" value=\"4\" aria-errormessage=\"wpforms-152-field_7_4-error\" aria-describedby=\"wpforms-152-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_7_4\">4<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_7_5\" name=\"wpforms[fields][7]\" value=\"5\" aria-errormessage=\"wpforms-152-field_7_5-error\" aria-describedby=\"wpforms-152-field_7-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_7_5\">5<\/label><\/li><\/ul><div id=\"wpforms-152-field_7-description\" class=\"wpforms-field-description\">Please rate us using the scale: 5 = Very Satisfied, 4 = Satisfied, 3 = Neutral, 2 =  Dissatisfied, 1 = Very Dissatisfied. <\/div><\/fieldset><\/div><div id=\"wpforms-152-field_14-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"14\"><fieldset><legend class=\"wpforms-field-label\">How likely are you to recommend our services to family, friends who are in need of our services? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-152-field_14\" class=\"wpforms-field-required\"><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_14_2\" name=\"wpforms[fields][14]\" value=\"1\" aria-errormessage=\"wpforms-152-field_14_2-error\" aria-describedby=\"wpforms-152-field_14-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_14_2\">1<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_14_3\" name=\"wpforms[fields][14]\" value=\"2\" aria-errormessage=\"wpforms-152-field_14_3-error\" aria-describedby=\"wpforms-152-field_14-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_14_3\">2<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_14_4\" name=\"wpforms[fields][14]\" value=\"3\" aria-errormessage=\"wpforms-152-field_14_4-error\" aria-describedby=\"wpforms-152-field_14-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_14_4\">3<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_14_5\" name=\"wpforms[fields][14]\" value=\"4\" aria-errormessage=\"wpforms-152-field_14_5-error\" aria-describedby=\"wpforms-152-field_14-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_14_5\">4<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_14_6\" name=\"wpforms[fields][14]\" value=\"5\" aria-errormessage=\"wpforms-152-field_14_6-error\" aria-describedby=\"wpforms-152-field_14-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_14_6\">5<\/label><\/li><\/ul><div id=\"wpforms-152-field_14-description\" class=\"wpforms-field-description\">Please rate us using the scale: 5 = Very Likely, 4 = Likely, 3 = Neutral, 2 =  Not really, 1 = Very Dissatisfied. <\/div><\/fieldset><\/div><div id=\"wpforms-152-field_9-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"9\"><fieldset><legend class=\"wpforms-field-label\">Did you feel cared for while you were with us? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-152-field_9\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_9_1\" name=\"wpforms[fields][9]\" value=\"Yes\" aria-errormessage=\"wpforms-152-field_9_1-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_9_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_9_2\" name=\"wpforms[fields][9]\" value=\"No\" aria-errormessage=\"wpforms-152-field_9_2-error\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_9_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-152-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-152-field_2\">Please share a few words about your experience on this journey with us. <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><textarea id=\"wpforms-152-field_2\" class=\"wpforms-field-medium wpforms-field-required wpforms-limit-characters-enabled\" data-form-id=\"152\" data-field-id=\"2\" data-text-limit=\"300\" name=\"wpforms[fields][2]\" placeholder=\"Please elaborate your experience in maximum 300 characters..\" aria-errormessage=\"wpforms-152-field_2-error\" maxlength=\"300\" required><\/textarea><\/div><div id=\"wpforms-152-field_13-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-id=\"13\"><fieldset><legend class=\"wpforms-field-label\">May we use your Feedback on Social Media, Website? <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><ul id=\"wpforms-152-field_13\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_13_1\" name=\"wpforms[fields][13]\" value=\"Yes\" aria-errormessage=\"wpforms-152-field_13_1-error\" aria-describedby=\"wpforms-152-field_13-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_13_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-152-field_13_2\" name=\"wpforms[fields][13]\" value=\"No\" aria-errormessage=\"wpforms-152-field_13_2-error\" aria-describedby=\"wpforms-152-field_13-description\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-152-field_13_2\">No<\/label><\/li><\/ul><div id=\"wpforms-152-field_13-description\" class=\"wpforms-field-description\">Please click SUBMIT for the response to get recorded.\r\n<\/div><\/fieldset><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-recaptcha-container wpforms-is-recaptcha\" ><div class=\"g-recaptcha\" data-sitekey=\"6LeQu-woAAAAACJSEWWQBEwWBQ8u3P4j4mH-VEJw\" data-size=\"invisible\"><\/div><\/div><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"152\"><input type=\"hidden\" name=\"wpforms[author]\" value=\"1\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-152\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"SUBMIT\" aria-live=\"assertive\" value=\"wpforms-submit\">SUBMIT<\/button><img decoding=\"async\" loading=\"lazy\" src=\"https:\/\/careinsignia.com\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->","protected":false},"excerpt":{"rendered":"<p>Hi, We hope you are well and you have had a fruitful time with us throughout our time together. We look forward to hearing back from you. Your opinion matters, and we would appreciate if you write to us about your experience with us.<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/careinsignia.com\/index.php\/wp-json\/wp\/v2\/pages\/349"}],"collection":[{"href":"https:\/\/careinsignia.com\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/careinsignia.com\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/careinsignia.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/careinsignia.com\/index.php\/wp-json\/wp\/v2\/comments?post=349"}],"version-history":[{"count":12,"href":"https:\/\/careinsignia.com\/index.php\/wp-json\/wp\/v2\/pages\/349\/revisions"}],"predecessor-version":[{"id":480,"href":"https:\/\/careinsignia.com\/index.php\/wp-json\/wp\/v2\/pages\/349\/revisions\/480"}],"wp:attachment":[{"href":"https:\/\/careinsignia.com\/index.php\/wp-json\/wp\/v2\/media?parent=349"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}